Healthcare Provider Details

I. General information

NPI: 1821122441
Provider Name (Legal Business Name): GINA MARIE MODENA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA MARIE JONES APRN

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N FORGE ST STE 400
AKRON OH
44304
US

IV. Provider business mailing address

875 N. MUNROE RD
TALLMADGE OH
44278
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-7494
  • Fax: 330-375-7499
Mailing address:
  • Phone: 330-715-8486
  • Fax: 330-375-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10791
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0357076-21
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number10791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: