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General NPI Number Information
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NPI Number | 1508892001
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Entity Type | Individual
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Provider Name | MARYELLEN BELISLE APRN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 98 N WASHINGTON ST STE 107
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City | BOSTON
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State | MA
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Zip | 02114-1913
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Country | US
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Telephone | 617-921-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 57 ELM ST
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City | CHARLESTOWN
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State | MA
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Zip | 02129-2421
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 051433-23-02
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN206958
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License Number State | MA
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