Provider Demographics
NPI:1255830535
Name:RESIL, JUSTIN JR (RN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:RESIL
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 JOHN BERMAN DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2431
Mailing Address - Country:US
Mailing Address - Phone:508-846-2755
Mailing Address - Fax:
Practice Address - Street 1:599 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2512
Practice Address - Country:US
Practice Address - Phone:508-894-1126
Practice Address - Fax:508-894-1129
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2316620163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse