Provider Demographics
NPI:1245489939
Name:NORBY, RANDI LEE (CNS)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:LEE
Last Name:NORBY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:LEE
Other - Last Name:GRONHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 1ST AVE NE
Mailing Address - Street 2:STE 310
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2419
Mailing Address - Country:US
Mailing Address - Phone:612-436-0295
Mailing Address - Fax:612-436-0163
Practice Address - Street 1:615 1ST AVE NE
Practice Address - Street 2:STE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2419
Practice Address - Country:US
Practice Address - Phone:612-436-0295
Practice Address - Fax:612-436-0163
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 118654 I364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent