Provider Demographics
NPI:1114137650
Name:BELASCO, KIMBERLY ANN (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:BELASCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-3447
Mailing Address - Country:US
Mailing Address - Phone:609-729-4037
Mailing Address - Fax:
Practice Address - Street 1:1 MUNRO AVE
Practice Address - Street 2:
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11150200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse