Basic Information
| Provider Information | |||||||||
| NPI: | 1730455692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUISON | ||||||||
| FirstName: | RANDEE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 VICTORY DRIVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168832660 | ||||||||
| FaxNumber: | 8167929819 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 S 17TH ST | ||||||||
| Address2: | SUITE 1B | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685022641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024751831 | ||||||||
| FaxNumber: | 4024754257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2012 | ||||||||
| LastUpdateDate: | 04/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 000973 | MO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 786 | NE | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.