Individual
MRS. LISA MARIE RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERT.TECH
Contact information
Practice address
970 COUNTY ROUTE 56, POTSDAM, NY 13676-3351
(315) 212-7817
Mailing address
970 COUNTY ROUTE 56, POTSDAM, NY 13676
(315) 212-7817
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912269226
GROUP NPI
NY
Enumeration date
04/27/2012
Last updated
11/08/2012
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