Provider Demographics
NPI:1013395474
Name:RESKE, CARA (CPNP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:RESKE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3212
Mailing Address - Country:US
Mailing Address - Phone:410-284-1133
Mailing Address - Fax:410-284-3371
Practice Address - Street 1:1792 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-3212
Practice Address - Country:US
Practice Address - Phone:410-284-1133
Practice Address - Fax:410-284-3371
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202772363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD339517100Medicaid