NPI 1508892001 · live from the CMS NPI Registry
Maryellen Belisle, APRN
Nurse Practitioner, Family in Boston, MA. National Provider Identifier 1508892001, active.
NPI record
| NPI | 1508892001 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 98 N Washington St Ste 107, Boston, MA 02114 |
| Practice phone | 617-921-0962 |
| Mailing address | 57 Elm St, Charlestown, MA 02129 |
| Enumerated | June 25, 2006 |
| Last updated | February 18, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics | 363LP0200X | 051433-23-02 (NH) |
| Nurse Practitioner, Family primary | 363LF0000X | RN206958 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.