Provider Demographics
NPI:1407504111
Name:HART, RANDI LEE
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LEE
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 ELBOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5712
Mailing Address - Country:US
Mailing Address - Phone:701-751-8260
Mailing Address - Fax:701-751-2274
Practice Address - Street 1:22 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSHALL
Practice Address - State:ND
Practice Address - Zip Code:58770
Practice Address - Country:US
Practice Address - Phone:701-862-2490
Practice Address - Fax:701-862-4355
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDDUM00000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator