Individual
MS. LISA RENEE MODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1400 PEHHAM PKWY SO., RM 3W7 MIDWIFERY OFFICE, BRONX, NY 10461
(718) 918-6326
(718) 918-6318
Mailing address
1400 PEHHAM PKWY SO., TM 3W7 MIDWIFERY OFFICE, BRONX, NY 10461
(718) 918-6326
(718) 918-6318
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
001199
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02708836
—
NY
Enumeration date
12/27/2006
Last updated
09/08/2015
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