Provider Demographics
NPI:1134136443
Name:RANDALL, STEPHANIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6911 VAN DORN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6801
Mailing Address - Country:US
Mailing Address - Phone:402-616-9144
Mailing Address - Fax:
Practice Address - Street 1:6911 VAN DORN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6801
Practice Address - Country:US
Practice Address - Phone:402-489-4186
Practice Address - Fax:402-489-5279
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23381207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology