Individual
DUSTIN CHARLES RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
804 S. WALNUT STREET, FREEMAN, SD 57029
(605) 925-4219
(605) 925-4220
Mailing address
804 S WALNUT ST, FREEMAN, SD 57029-2033
(605) 925-4219
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CP000712
SD
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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