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NPI Code Detail

MEDICARE: MARC BELISLE

MEDICARE:   MARC  BELISLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN01735RI

General Provider Information

NPI Number : 1649785262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC BELISLE
Provider Business Mailing Address
First Line : 117 ELLENFIELD ST STE 101
Second Line :
City : PROVIDENCE
State : RI
Zip : 02905-4541
Country : US
Telephone Number : 401-444-6779
Fax Number : 401-444-6912
Provider Business Practice Location Address
First Line : 1360 W MAIN RD
Second Line :
City : MIDDLETOWN
State : RI
Zip : 02842-6301
Country : US
Telephone Number : 401-606-3110
Fax Number : 401-619-8969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2017
Last Update Date : 08/29/2019

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Directions to “ MARC BELISLE ” Practice Location

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