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General NPI Number Information
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NPI Number | 1386963486
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Entity Type | Individual
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Provider Name | ROBERTA ANN BELLER ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 325 EAST H STREET OSCAR G. JOHNSON VA MEDICAL CENTER,
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-4792
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Country | US
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Telephone | 906-774-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 W NATIONAL AVE BLDG 39
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City | MILWAUKEE
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State | WI
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Zip | 53295-0001
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Country | US
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Telephone | 414-212-8060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 163779-39
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License Number State | WI
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