Provider Demographics
NPI:1871850644
Name:BELLO, WAHEED
Entity Type:Individual
Prefix:MR
First Name:WAHEED
Middle Name:
Last Name:BELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 W PARKMOOR CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1589
Mailing Address - Country:US
Mailing Address - Phone:414-817-2460
Mailing Address - Fax:
Practice Address - Street 1:2823 W PARKMOOR CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1589
Practice Address - Country:US
Practice Address - Phone:414-817-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI181880-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse