Individual
MARY L RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
39350 9 MILE RD, NORTHVILLE, MI 48167-9164
(248) 442-8130
Mailing address
3035 25TH ST, DETROIT, MI 48216-1001
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704228366
MI
Other
Enumeration date
01/08/2021
Last updated
01/08/2021
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