Provider Demographics
NPI:1245471267
Name:BELCHER, OPAL SUE (LPN)
Entity type:Individual
Prefix:MRS
First Name:OPAL
Middle Name:SUE
Last Name:BELCHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1551
Mailing Address - Country:US
Mailing Address - Phone:414-839-9833
Mailing Address - Fax:
Practice Address - Street 1:3312 PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1551
Practice Address - Country:US
Practice Address - Phone:414-839-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307821-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse