Individual
REENA MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
675 N SAINT CLAIR ST, GALTER SUITE 20-100, CHICAGO, IL 60611-5975
(312) 695-0990
Mailing address
676 N SAINT CLAIR ST, SUITE 850, CHICAGO, IL 60611-2927
(312) 695-0738
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209014360
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
209014360
IL
Other
Enumeration date
11/16/2016
Last updated
06/13/2017
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