Healthcare Provider Details

I. General information

NPI: 1063998250
Provider Name (Legal Business Name): REBECCA BELTOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD K14 CARDIOLOGY
DETROIT MI
48202-2608
US

IV. Provider business mailing address

3823 WESTPHAL RD
HOWELL MI
48843-8899
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2417
  • Fax: 313-916-8419
Mailing address:
  • Phone: 734-255-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704283150
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704283150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: