Provider Demographics
NPI:1851132914
Name:RANDALL, MARSHALL CHRISTIAN (DVM, RN)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:CHRISTIAN
Last Name:RANDALL
Suffix:
Gender:M
Credentials:DVM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:MI
Mailing Address - Zip Code:49729-0123
Mailing Address - Country:US
Mailing Address - Phone:231-588-2190
Mailing Address - Fax:
Practice Address - Street 1:9251 LAKE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:MI
Practice Address - Zip Code:49729-9665
Practice Address - Country:US
Practice Address - Phone:231-588-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse