Provider Demographics
NPI:1508924473
Name:RESLER, MARY E (CRNFA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:RESLER
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:M.
Other - Middle Name:E
Other - Last Name:RESLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNFA
Mailing Address - Street 1:PO BOX 1356
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0101
Mailing Address - Country:US
Mailing Address - Phone:541-734-1660
Mailing Address - Fax:541-878-4882
Practice Address - Street 1:1111 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6241
Practice Address - Country:US
Practice Address - Phone:541-732-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR238936Medicaid