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General NPI Number Information
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NPI Number | 1659878635
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Entity Type | Individual
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Provider Name | LENA MODIEH NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 6701 159TH ST
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City | TINLEY PARK
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State | IL
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Zip | 60477
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Country | US
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Telephone | 708-429-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 GREEN RD STE 300
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City | ANN ARBOR
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State | MI
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Zip | 48105-1575
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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 | 209.017130
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 710094088A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.017130
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License Number State | IL
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