Provider Demographics
NPI:1548959166
Name:BELBA, RANDA LYNN (RN)
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:LYNN
Last Name:BELBA
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 1:209 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1737
Mailing Address - Country:US
Mailing Address - Phone:618-530-6219
Mailing Address - Fax:
Practice Address - Street 1:209 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1737
Practice Address - Country:US
Practice Address - Phone:618-530-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041335679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse