Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | BM6733807-Q141 | GA |
N | 208600000X | Surgeon | BM6733807-Q141 | GA |
Y | 2086S0120X | Pediatric Surgery | 70005 | MN |
NPI | 1619239613 |
---|---|
Provider Name | Dr. Randi Leigh Sessoms Lassiter |
First Address | Minneapolis, MN 55454-1450 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 28/09/2021 |