MEDICARE: LEESA MARIE BELUS AGACNP-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	363LA2100X	Acute Care Nurse Practitioner	15089-1709	WY

General Provider Information

NPI Number	:	1477061836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEESA MARIE BELUS AGACNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 327
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-0327
Country	:	US
Telephone Number	:	307-620-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 SUGARLAND DR STE 103
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5719
Country	:	US
Telephone Number	:	307-673-4960
Fax Number	:	307-673-4951

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

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	01/18/2018

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