MEDICARE: MRS. ROBERTA ANN BELLER ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	163779-39	WI

General Provider Information

NPI Number	:	1386963486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBERTA ANN BELLER ANP-BC

Provider Business Mailing Address
First Line	:	5000 W NATIONAL AVE BLDG 39
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53295-0001
Country	:	US
Telephone Number	:	414-212-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 EAST H STREET
Second Line	:	OSCAR G. JOHNSON VA MEDICAL CENTER,
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-4792
Country	:	US
Telephone Number	:	906-774-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	05/28/2010

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