Active NPI
Marshall Christian Randall, DVM, RN
- Registered Nurse
- Ellsworth, MI
National Provider Identifier
1851132914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704206440
- Practice address
- 9251 Lake St
Ellsworth, MI 49729-9665 - Phone
- (231) 588-2190
- NPI assigned
- Jun 3, 2024
- Last updated
- Jun 3, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704206440 | MI | Primary |
Addresses
Primary practice location
9251 Lake St
Ellsworth, MI 49729-9665
Mailing address
PO Box 123
Ellsworth, MI 49729-0123
Phone (231) 588-2190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704206440 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717372800000",
"number": "1851132914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 123",
"city": "ELLSWORTH",
"state": "MI",
"postal_code": "497290123",
"telephone_number": "231-588-2190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9251 LAKE ST",
"city": "ELLSWORTH",
"state": "MI",
"postal_code": "497299665",
"telephone_number": "231-588-2190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "MARSHALL",
"middle_name": "CHRISTIAN",
"name_prefix": "Dr.",
"credential": "DVM, RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-03",
"last_updated": "2024-06-03",
"certification_date": "2024-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704206440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellsworth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.