Individual
BECKY RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1406 6TH AVE N, ST. CLOUD, MN 56303-1901
(763) 742-7684
Mailing address
15364 92ND ST NE, OTSEGO, MN 55330-7209
(763) 742-7684
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12679
MN
Other
Enumeration date
06/28/2018
Last updated
11/22/2021
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