| NPI | 1407382062 |
|---|---|
| Former Name | MELISSA BETH RANDALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601008180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008180) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601008180) | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2021-05-08 |