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Individual
MR. TERRY CARSON BELISLE
Active
Individual
MR. TERRY CARSON BELISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001222794
VA
363LF0000X
Family Nurse Practitioner
Primary
0024172789
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001222794
BOARD OF NURSING
VA
01
—
0024172789
BOARD OF NURSING
VA
Enumeration date
07/22/2015
Last updated
07/22/2015
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