Individual provider Active NPI

Haley Marie Resnick, PA-S

  • Physician Assistant
  • Davenport, IA
National Provider Identifier
1962018655
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1320 W Lombard St
Davenport, IA 52804-2029
Phone
(563) 333-6069
NPI assigned
Sep 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1320 W Lombard St
Davenport, IA 52804-2029

Mailing address

1320 W Lombard St
Davenport, IA 52804-2029
Phone (563) 333-6069

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220210001950 IL Practitioner - Physician Assistant 8729471990 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System CurrentSince Jun 17, 2024 Accepting new patients

Locations

1351 W Central Park Ave
Ste 4100
Davenport, IA 52804
Phone (563) 355-9191

801 Illini Dr
Silvis, IL 61282
Phone (309) 281-4000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1962018655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W LOMBARD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528042029",
            "telephone_number": "563-333-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W LOMBARD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528042029",
            "telephone_number": "563-333-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RESNICK",
        "first_name": "HALEY",
        "middle_name": "MARIE",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.