Provider Demographics
NPI:1871693861
Name:BELANUS, JANN (RPT)
Entity type:Individual
Prefix:
First Name:JANN
Middle Name:
Last Name:BELANUS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:JANN
Other - Middle Name:
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1521 SWEETWATER DR NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 14TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2808
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:763-689-5558
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8B755BEOtherBLUE CROSS BLUE SHIELD
MN6411235OtherMEDICA
ND15646OtherBLUE CROSS BLUE SHIELD
ND59922Medicaid
ND59922Medicaid