Healthcare Provider Details

I. General information

NPI: 1003743089
Provider Name (Legal Business Name): RANDI NICHOLS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 W 7TH ST
CARROLL IA
51401-2206
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-3144
  • Fax:
Mailing address:
  • Phone: 800-769-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number126509
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: