Provider Demographics
NPI:1801548318
Name:RANDALL, MELISSA ZOE (DNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ZOE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ZOE
Other - Last Name:PURSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:215 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8471
Mailing Address - Country:US
Mailing Address - Phone:406-212-4006
Mailing Address - Fax:
Practice Address - Street 1:1675 TALBOT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4569
Practice Address - Country:US
Practice Address - Phone:406-892-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-218100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner