Provider Demographics
NPI:1225500200
Name:RESNIK, JULIE MARIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:RESNIK
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:FREDERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3 WILLI LN
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2506
Mailing Address - Country:US
Mailing Address - Phone:860-930-9814
Mailing Address - Fax:860-812-2244
Practice Address - Street 1:3 WILLI LN
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2506
Practice Address - Country:US
Practice Address - Phone:860-930-9814
Practice Address - Fax:860-812-2244
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4234935163WC0400X
CTNONE163WH0200X
WI2005457394163WW0000X
CTE56706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE56706OtherI DONT HAVE THEM