Provider Demographics
NPI:1710742473
Name:WESTON, RANDY LEE
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:WESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ROSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48654-9573
Mailing Address - Country:US
Mailing Address - Phone:989-390-1076
Mailing Address - Fax:
Practice Address - Street 1:200 BENNETT ST
Practice Address - Street 2:
Practice Address - City:ROSE CITY
Practice Address - State:MI
Practice Address - Zip Code:48654-9504
Practice Address - Country:US
Practice Address - Phone:989-390-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider