Provider Demographics
NPI:1386005635
Name:HUMMEL, RANDI M (APN)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:M
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:M
Other - Last Name:HUMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:6810 STATE ROUTE 162
Mailing Address - Street 2:BOX 215
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-391-6495
Mailing Address - Fax:
Practice Address - Street 1:6812 STATE ROUTE 162 STE 204
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8562
Practice Address - Country:US
Practice Address - Phone:618-391-5070
Practice Address - Fax:618-288-1872
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner