Healthcare Provider Details

I. General information

NPI: 1982131702
Provider Name (Legal Business Name): RANDY KAUK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 E PENSTAMIN DR
SCOTTSDALE AZ
85255-2446
US

IV. Provider business mailing address

10448 E PENSTAMIN DR
SCOTTSDALE AZ
85255-2446
US

V. Phone/Fax

Practice location:
  • Phone: 313-587-7228
  • Fax:
Mailing address:
  • Phone: 313-587-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN168849
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP11037
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: