Healthcare Provider Details

I. General information

NPI: 1306284153
Provider Name (Legal Business Name): RACHEL S BELDO-ROSA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 5TH ST SE
COOK MN
55723-9702
US

IV. Provider business mailing address

20 5TH ST SE
COOK MN
55723-9702
US

V. Phone/Fax

Practice location:
  • Phone: 218-666-5941
  • Fax:
Mailing address:
  • Phone: 218-666-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 179723 1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: