Provider Demographics
NPI:1518171032
Name:SENIBO, BELEMA ATELISIKA (RN)
Entity Type:Individual
Prefix:
First Name:BELEMA
Middle Name:ATELISIKA
Last Name:SENIBO
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 1:1080 CHURCHILL CT
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5903
Mailing Address - Country:US
Mailing Address - Phone:612-703-3535
Mailing Address - Fax:
Practice Address - Street 1:2147 UNIVERSITY AVE W STE 214
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1327
Practice Address - Country:US
Practice Address - Phone:651-647-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 164764-0163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health