MEDICARE: MS. AMI DAWN RANDALL R.N.

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	163WC0400X	Case Management Registered Nurse	RN-347666	OH

General Provider Information

NPI Number	:	1962733105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMI DAWN RANDALL R.N.

Provider Business Mailing Address
First Line	:	431 HIGHLAND HILLS CIR
Second Line	:
City	:	HOWARD
State	:	OH
Zip	:	43028-9298
Country	:	US
Telephone Number	:	740-504-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 HIGHLAND HILLS CIR
Second Line	:
City	:	HOWARD
State	:	OH
Zip	:	43028-9298
Country	:	US
Telephone Number	:	740-504-5977
Fax Number	:

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	05/17/2026

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