Individual
MS. CYNTHIA J MODLIN-ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN MSN ANP BC BYANCC
Contact information
Practice address
1501 HARTFORD ST, LAFAYETTE, IN 47904-2134
(765) 446-4838
(765) 446-4851
Mailing address
1501 HARTFORD ST, LAFAYETTE, IN 47904-2134
(765) 446-4838
(765) 446-4851
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP71000092A
IN
363L00000X
Nurse Practitioner
Primary
RN28084777A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000559485
ANTHEM
IN
05
—
200941060
—
IN
01
—
500006273
RAILROAD MEDICARE
IN
01
—
9397607
PHCS PID NUMBER
IN
Enumeration date
03/20/2006
Last updated
03/07/2023
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