Provider Demographics
NPI:1811766405
Name:REZSNYAK, KARA LEE (NBC-HWC)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:LEE
Last Name:REZSNYAK
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 MARCELLO AVE
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6349
Mailing Address - Country:US
Mailing Address - Phone:425-223-2222
Mailing Address - Fax:
Practice Address - Street 1:1195 MARCELLO AVE
Practice Address - Street 2:
Practice Address - City:TONTITOWN
Practice Address - State:AR
Practice Address - Zip Code:72762-6349
Practice Address - Country:US
Practice Address - Phone:425-223-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-3198271171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach