Provider Demographics
NPI:1548536048
Name:RESNIK, DIANE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RESNIK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 PEDDLERS VILLAGE RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1004
Mailing Address - Country:US
Mailing Address - Phone:574-534-1135
Mailing Address - Fax:
Practice Address - Street 1:2606 PEDDLERS VILLAGE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1004
Practice Address - Country:US
Practice Address - Phone:574-534-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28101496A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily