Purcell, Randy L

Purcell, Randy L is an individual health care provider with primary practice located at 205 Valley Ave , West Bend WI 53095-5312. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Purcell, Randy L can be contacted via phone (262) 338-1123.

Contact Information

Primary practice address
205 Valley Ave West Bend WI 53095-5312
Phone: (262) 338-1123
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 322-023 Wisconsin

Profile Details

NPI number 1407963713
LBN Legal business name Purcell, Randy L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2006
Last updated Dec 3rd, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407963713 NPPES
Wisconsin MEDICAID 42906500

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