Provider Demographics
NPI:1447609425
Name:RANDALL, MAUREEN LEE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:LEE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:417 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1198
Mailing Address - Country:US
Mailing Address - Phone:218-879-1271
Mailing Address - Fax:218-655-0017
Practice Address - Street 1:927 TRETTEL LN
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1345
Practice Address - Country:US
Practice Address - Phone:218-879-1227
Practice Address - Fax:218-878-3718
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNCNP4552363LF0000X
MNCNP 4552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily