Provider Demographics
NPI:1942205380
Name:RESNICK, BARBARA (PHD, CRNP, FAAN ,FAA)
Entity Type:Individual
Prefix:PROF
First Name:BARBARA
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:PHD, CRNP, FAAN ,FAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 CLOVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1708
Mailing Address - Country:US
Mailing Address - Phone:443-812-2735
Mailing Address - Fax:
Practice Address - Street 1:3907 CLOVERHILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1708
Practice Address - Country:US
Practice Address - Phone:443-812-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079215363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S32331Medicare UPIN