Individual
NICOLE MODELL
Active
Individual
NICOLE MODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6843
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6843
STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH PHYSICIAN ASSISTANT LICENSE
CT
Enumeration date
08/06/2024
Last updated
11/13/2024
Update your record
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