Provider Demographics
NPI:1902567134
Name:RANDALL, LISA JEAN
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JEAN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3665 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2445
Mailing Address - Country:US
Mailing Address - Phone:989-799-6542
Mailing Address - Fax:
Practice Address - Street 1:3665 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2445
Practice Address - Country:US
Practice Address - Phone:989-799-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator