MEDICARE: MISS JAMIE LEE MODAFFARI MSN, CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP011590	PA

General Provider Information

NPI Number	:	1467729145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE LEE MODAFFARI MSN, CRNP

Provider Business Mailing Address
First Line	:	8950 DUNCAN AVE FL 4
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5803
Country	:	US
Telephone Number	:	412-847-1290
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 DUNCAN AVE FL 4
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5803
Country	:	US
Telephone Number	:	412-847-1290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	10/13/2021

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