1588623573 NPI number — MS. CYNTHIA J MODLIN-ADAMS RN MSN ANP BC BYANCC

Table of content: MS. CYNTHIA J MODLIN-ADAMS RN MSN ANP BC BYANCC (NPI 1588623573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588623573 NPI number — MS. CYNTHIA J MODLIN-ADAMS RN MSN ANP BC BYANCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MODLIN-ADAMS
Provider First Name:
CYNTHIA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN MSN ANP BC BYANCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
CINDY
Provider Other Middle Name:
MODLIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588623573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 HARTFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47904-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-446-4838
Provider Business Mailing Address Fax Number:
765-446-4851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 HARTFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47904-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-446-4838
Provider Business Practice Location Address Fax Number:
765-446-4851
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN28084777A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: NP71000092A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9397607 . This is a "PHCS PID NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200941060 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000559485 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 500006273 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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