Provider Demographics
NPI:1962733105
Name:RANDALL, AMI DAWN (RN)
Entity type:Individual
Prefix:MS
First Name:AMI
Middle Name:DAWN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 HIGHLAND HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9298
Mailing Address - Country:US
Mailing Address - Phone:740-504-5977
Mailing Address - Fax:
Practice Address - Street 1:431 HIGHLAND HILLS CIR
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:OH
Practice Address - Zip Code:43028-9298
Practice Address - Country:US
Practice Address - Phone:740-504-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-347666163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management