MEDICARE: MELISSA ZOE RANDALL DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NUR-APRN-LIC-218100	MT

General Provider Information

NPI Number	:	1801548318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ZOE RANDALL DNP

Provider Business Mailing Address
First Line	:	215 EMERALD DR
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-8471
Country	:	US
Telephone Number	:	406-212-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 TALBOT RD
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4569
Country	:	US
Telephone Number	:	406-892-3208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	05/27/2025

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