# MS. JENNIFER CHRISTINE MODESTO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750483244
- **Gender:** F
- **Credential:** B.S., PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 5601004881 | MI | Yes |

## Other

- **Enumeration date:** 09/04/2006
- **Last updated:** 12/17/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7463850 | AETNA | — |
| 01 | — | P00349237 | MEDICARE RAILROAD | MI |