Individual
MEGAN L M RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 780-9155
(763) 236-1066
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2046
MN
363A00000X
Physician Assistant
Primary
12046
MN
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1132616
NCCPA
—
Enumeration date
02/26/2016
Last updated
08/26/2024
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