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General NPI Number Information
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NPI Number | 1396391728
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Entity Type | Individual
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Provider Name | BRIANN N. MODOS APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 6515 GRAND TETON PLZ STE 220
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City | MADISON
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State | WI
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Zip | 53719-1048
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Country | US
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Telephone | 608-713-9898
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Fax | 608-713-9647
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Provider Business Mailing Address
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Address Line | 6515 GRAND TETON PLZ STE 220
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City | MADISON
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State | WI
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Zip | 53719-1048
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Country | US
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Telephone | 608-713-9898
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Fax | 608-713-9647
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 218791-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9370-33
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License Number State | WI
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