Provider Demographics
NPI:1003355934
Name:BELEN, KURT (RN)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:BELEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 DUPREY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1295
Mailing Address - Country:US
Mailing Address - Phone:313-410-1988
Mailing Address - Fax:
Practice Address - Street 1:10814 DUPREY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1295
Practice Address - Country:US
Practice Address - Phone:313-410-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-12
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723510367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered