Provider Demographics
NPI:1053419481
Name:RESENDES TRAINOR, LORIE (NP)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:RESENDES TRAINOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:A
Other - Last Name:RESENDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:819 WORCESTER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1056
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:30 NORTHAMPTON STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-0211
Practice Address - Country:US
Practice Address - Phone:888-522-2199
Practice Address - Fax:617-286-3107
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704113Medicaid
MA0704113Medicaid