Provider Demographics
NPI:1891239091
Name:RESIL, MOLORE J (FNP)
Entity Type:Individual
Prefix:
First Name:MOLORE
Middle Name:J
Last Name:RESIL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2512
Mailing Address - Country:US
Mailing Address - Phone:508-894-1126
Mailing Address - Fax:508-894-1129
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?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF1116129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily