Individual
KELLY R RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
200 W ALONA LN, LANCASTER, WI 53813-2202
(608) 723-6357
(608) 723-4417
Mailing address
200 W ALONA LN, LANCASTER, WI 53813-2202
(608) 723-6357
(608) 723-4417
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
119887-30
WI
Other
Enumeration date
01/11/2013
Last updated
01/11/2013
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