1992705966 NPI number — DR. JANELL MARIE RANDA D.C.

Table of content: DR. JANELL MARIE RANDA D.C. (NPI 1992705966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992705966 NPI number — DR. JANELL MARIE RANDA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDA
Provider First Name:
JANELL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMMERSCHMIDT
Provider Other First Name:
JANELL
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992705966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 1ST AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARMONY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55939-6612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-886-6051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 1ST AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARMONY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55939-6612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-886-6051
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3435 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6C252 HA . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 607516900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0347 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0347 . This is a "HEALTH SERVICES MANAGEMEN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0522318 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".