Provider Demographics
NPI:1780667360
Name:BRESOLIN, JOEL PAUL (NP)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:PAUL
Last Name:BRESOLIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-973-7765
Mailing Address - Fax:855-414-1745
Practice Address - Street 1:2016 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-973-7765
Practice Address - Fax:855-414-1745
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11409204C00000X
CARN432043146N00000X
CA432043363L00000X, 363LX0106X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health