Provider Demographics
NPI:1740944610
Name:BELLOSA, DEANNE MARGARET LIM (MD)
Entity type:Individual
Prefix:
First Name:DEANNE MARGARET
Middle Name:LIM
Last Name:BELLOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:LIM
Other - Last Name:BELLOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1851 N MCKENZIE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-4702
Mailing Address - Country:US
Mailing Address - Phone:251-677-6825
Mailing Address - Fax:
Practice Address - Street 1:1851 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-4700
Practice Address - Country:US
Practice Address - Phone:251-424-1232
Practice Address - Fax:251-424-1954
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.5915R390200000X, 390200000X
HI3447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty