Provider Demographics
NPI:1215363197
Name:RANDALL, RACHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHELE
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHELE
Other - Middle Name:
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 W 5TH ST # STC
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-3027
Mailing Address - Country:US
Mailing Address - Phone:319-231-3943
Mailing Address - Fax:
Practice Address - Street 1:1200 1ST AVE E STE C
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:712-262-7511
Practice Address - Fax:712-262-3658
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant