Healthcare Provider Details

I. General information

NPI: 1164723219
Provider Name (Legal Business Name): AMY C RANDALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

4981 NORTHFIELD DR
MONROE MI
48161-5434
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5800
  • Fax:
Mailing address:
  • Phone: 734-652-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704210694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: