Healthcare Provider Details

I. General information

NPI: 1871376137
Provider Name (Legal Business Name): KASEY BELAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 CHESTNUT ST
SPRINGFIELD MA
01107-2007
US

IV. Provider business mailing address

12 ROCKET RUN
ENFIELD CT
06082-5050
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-1431
  • Fax:
Mailing address:
  • Phone: 860-929-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2354355
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: