Provider Demographics
NPI:1114173762
Name:HIPWELL, RANDALL CHARLES (ACNP-C)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CHARLES
Last Name:HIPWELL
Suffix:
Gender:M
Credentials:ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3144
Mailing Address - Country:US
Mailing Address - Phone:801-652-9377
Mailing Address - Fax:801-581-4999
Practice Address - Street 1:2733 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3144
Practice Address - Country:US
Practice Address - Phone:801-652-9377
Practice Address - Fax:801-581-4999
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377763-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care