Individual
MARY PAT S RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
11461 FREDMAR DR, INTERLOCHEN, MI 49643-9523
(231) 590-8624
Mailing address
11461 FREDMAR DR, INTERLOCHEN, MI 49643-9523
(231) 590-8624
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
4704107861
MI
Other
Enumeration date
06/06/2013
Last updated
06/06/2013
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