Healthcare Provider Details

I. General information

NPI: 1447873500
Provider Name (Legal Business Name): DONNA MARIE RESSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 05/24/2020
Certification Date: 05/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 EXTON CMNS
EXTON PA
19341-2446
US

IV. Provider business mailing address

507 WILLIAM SALESBURY DR
DOWNINGTOWN PA
19335-4107
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-7557
  • Fax:
Mailing address:
  • Phone: 484-798-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH013361L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: