Healthcare Provider Details

I. General information

NPI: 1952768715
Provider Name (Legal Business Name): DANA RANDALL LMT, CDB, CPD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6227 RIVER RD
FLUSHING MI
48433-2565
US

IV. Provider business mailing address

6227 RIVER RD
FLUSHING MI
48433-2565
US

V. Phone/Fax

Practice location:
  • Phone: 810-908-9523
  • Fax:
Mailing address:
  • Phone: 810-908-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7501001338
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: