Ginger Bohn Randolph, FNP-C

Individual provider Active NPI Family Nurse Practitioner · Salem, WI

NPI 1508428707 · NPPES record last updated Jul 8, 2019

Key facts

NPI
1508428707
Entity type
Individual (NPI type 1)
Primary specialty
Family Nurse Practitioner 363LF0000X
License
9363-33 (WI)
Practice address
7137 236TH Ave
Salem, WI 53168-8975
Phone
(262) 846-4422
NPI assigned
Jul 8, 2019
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9363-33 WI Yes

Addresses

Primary practice location

7137 236TH Ave
Salem, WI 53168-8975

Mailing address

7137 236TH Ave
Salem, WI 53168-8975

Other providers in Salem, WI

All providers in Salem, WI · Family Nurse Practitioner in Wisconsin

Sources for this page

Verify at the official NPI Registry.