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Individual
MELISA RANDALL
Active
Individual
MELISA RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
583626
ID
363A00000X
Physician Assistant
Primary
PA-2359
ID
Other
Enumeration date
07/13/2022
Last updated
10/11/2022
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