Provider Demographics
NPI:1417799586
Name:MACHALK, RANDALL (RN)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:MACHALK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-0627
Mailing Address - Country:US
Mailing Address - Phone:715-579-0308
Mailing Address - Fax:
Practice Address - Street 1:475 CHIPPEWA MALL DR STE 418
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5047
Practice Address - Country:US
Practice Address - Phone:715-720-3780
Practice Address - Fax:715-720-7345
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149601163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care