| NPI | 1962181115 |
|---|---|
| Former Name | KANDISE ROSE MARIE BELISLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209028373) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041452140) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2024-02-08 |