Individual
JACQUELINE H MODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1912 MEMORIAL DR STE E, WAYCROSS, GA 31501-0989
(912) 283-7100
Mailing address
6115 COTTONWOOD LN, BLACKSHEAR, GA 31516-5992
(912) 286-4400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11006710
FL
363L00000X
Nurse Practitioner
Primary
RN240089
GA
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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