Provider Demographics
NPI:1467236265
Name:STECHSCHULTE, RANDI (NP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:STECHSCHULTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 LOUGHBOROUGH AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3619
Mailing Address - Country:US
Mailing Address - Phone:740-512-6787
Mailing Address - Fax:
Practice Address - Street 1:1 HALS PLZ STE A
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-1631
Practice Address - Country:US
Practice Address - Phone:573-223-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023034272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily