Healthcare Provider Details

I. General information

NPI: 1205467040
Provider Name (Legal Business Name): SANDRA KAY BELLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAYER RD
FRANKENMUTH MI
48734-1334
US

IV. Provider business mailing address

435 ARDUSSI ST
FRANKENMUTH MI
48734-1405
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-4463
  • Fax: 989-652-3279
Mailing address:
  • Phone: 989-928-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704319465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: