Provider Demographics
NPI:1689239741
Name:RESUE, MARCIA ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANNE
Last Name:RESUE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ANNNE
Other - Last Name:RESUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:455 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-1111
Mailing Address - Country:US
Mailing Address - Phone:697-377-9610
Mailing Address - Fax:
Practice Address - Street 1:455 W HIGH ST
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-1111
Practice Address - Country:US
Practice Address - Phone:697-377-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330289-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse