Provider Demographics
NPI:1184445058
Name:RANDALL, TRICIA (HEALTH COACH)
Entity type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 EDINGTON DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8753
Mailing Address - Country:US
Mailing Address - Phone:616-826-1726
Mailing Address - Fax:
Practice Address - Street 1:2422 BURTON ST SE STE D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4809
Practice Address - Country:US
Practice Address - Phone:616-826-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach