Individual
MS. MARYELLEN BELISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
98 N WASHINGTON ST STE 107, BOSTON, MA 02114-1913
(617) 921-0962
Mailing address
57 ELM ST, CHARLESTOWN, MA 02129-2421
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN206958
MA
363LP0200X
Pediatric Nurse Practitioner
051433-23-02
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30342268
—
NH
Enumeration date
06/25/2006
Last updated
02/18/2025
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