Provider Demographics
NPI:1376657874
Name:BELK, SUSAN M (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:BELK
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 1:255 N SMITH AVE.
Mailing Address - Street 2:ST PAUL HEART CLINIC
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-298-1296
Mailing Address - Fax:651-298-1203
Practice Address - Street 1:255 N SMITH AVENUE
Practice Address - Street 2:ST PAUL HEART CLINIC
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-298-1296
Practice Address - Fax:651-298-1203
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 900289-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse