Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 40409020 | WI |
N | 111NI0900X | Internist | 40409020 | WI |
Y | 207RC0200X | Critical Care Medicine | 40409 | WI |
NPI | 1073542221 |
---|---|
Provider Name | Laurin A Bellg |
First Address | Appleton, WI 54911-8735 |
Second Address | Appleton, WI 54911-8735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 29/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110239820 | RR MEDICARE (01) | |
34274400 | (05) | WI |
H65878 | (02) | WI |