Basic Information
| Provider Information | |||||||||
| NPI: | 1215363197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANDALL | ||||||||
| FirstName: | RACHELE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MONROE | ||||||||
| OtherFirstName: | RACHELE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1525 W 5TH ST # STC | ||||||||
| Address2: | |||||||||
| City: | STORM LAKE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505883027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192313943 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 1ST AVE E STE C | ||||||||
| Address2: | |||||||||
| City: | SPENCER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 513014342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122627511 | ||||||||
| FaxNumber: | 7122623658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.