Provider Demographics
NPI:1285771709
Name:RESNICK, KAREN A (CNM, RN, WHCNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:RESNICK
Suffix:
Gender:F
Credentials:CNM, RN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CHEVY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4127
Mailing Address - Country:US
Mailing Address - Phone:541-690-3555
Mailing Address - Fax:
Practice Address - Street 1:221 W STEWART AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3609
Practice Address - Country:US
Practice Address - Phone:541-535-6239
Practice Address - Fax:541-512-1026
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091007161RN163W00000X
OR200050012NP363LW0102X
OR091007161N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid
ORR142998Medicare PIN