Individual
ASHLIE LYNN RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
875 PERIMETER DR, MOSCOW, ID 83844-9803
(208) 885-6111
Mailing address
PO BOX 1857, WALDPORT, OR 97394-1857
(208) 318-8397
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0647098115
HPSO
ID
Enumeration date
01/14/2019
Last updated
01/14/2019
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