Provider Demographics
NPI:1861558959
Name:ALLEN-RANDALL, SALLY CATHERINE (RN)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:CATHERINE
Last Name:ALLEN-RANDALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SALLY
Other - Middle Name:CATHERINE
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1380 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:CARSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48419-9453
Mailing Address - Country:US
Mailing Address - Phone:810-677-0017
Mailing Address - Fax:
Practice Address - Street 1:217 E SANILAC RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1383
Practice Address - Country:US
Practice Address - Phone:810-648-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254677163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult