Healthcare Provider Details

I. General information

NPI: 1912378407
Provider Name (Legal Business Name): KRISTEN RESETAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAGEN DR STE 230
ROCHESTER NY
14625-2658
US

IV. Provider business mailing address

52 SUTTON PT
PITTSFORD NY
14534-4617
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-0140
  • Fax: 585-381-0582
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346629-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6960421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: