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Individual
MS. JENNIFER CHRISTINE MODESTO
Active
Individual
MS. JENNIFER CHRISTINE MODESTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S., PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004881
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7463850
AETNA
—
01
—
P00349237
MEDICARE RAILROAD
MI
Enumeration date
09/04/2006
Last updated
12/17/2020
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