Provider Demographics
NPI:1649575846
Name:RESENDES, EMMANUEL D (ANP-BC)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:D
Last Name:RESENDES
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:300 HANOVER ST STE 2A
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5451
Practice Address - Country:US
Practice Address - Phone:508-973-7774
Practice Address - Fax:508-973-7724
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner