Provider Demographics
NPI:1326681370
Name:RANDS, JESSICA RENEA (APNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEA
Last Name:RANDS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BUDD, PANDOLFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5211
Mailing Address - Fax:
Practice Address - Street 1:10212 N GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-7220
Practice Address - Country:US
Practice Address - Phone:715-634-6520
Practice Address - Fax:715-634-7055
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1143764163W00000X
KY3013758363LF0000X
WI13464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100652880Medicaid