Healthcare Provider Details

I. General information

NPI: 1942205380
Provider Name (Legal Business Name): BARBARA RESNICK PHD, CRNP, FAAN ,FAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 CLOVERHILL RD
BALTIMORE MD
21218-1708
US

IV. Provider business mailing address

3907 CLOVERHILL RD
BALTIMORE MD
21218-1708
US

V. Phone/Fax

Practice location:
  • Phone: 443-812-2735
  • Fax:
Mailing address:
  • Phone: 443-812-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR079215
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: