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General NPI Number Information
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NPI Number | 1548763915
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Entity Type | Individual
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Provider Name | LYNDSAY APRIL RANDALL NP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 1500 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1849
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Country | US
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Telephone | 231-672-6093
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Fax |
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Provider Business Mailing Address
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Address Line | 629 E SUNSET DR
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City | NORTH MUSKEGON
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State | MI
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Zip | 49445-3063
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Country | US
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Telephone | 231-736-4528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704303125
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License Number State | MI
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