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General NPI Number Information
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NPI Number | 1225991789
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Entity Type | Individual
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Provider Name | MARILY MODESTO APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 407 KENT ST
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City | MIDLAND
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State | TX
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Zip | 79701-5858
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Country | US
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Telephone | 432-687-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 ALAMOSA ST
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City | ODESSA
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State | TX
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Zip | 79763-2413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1218347
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License Number State | TX
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