Provider Demographics
NPI:1093478265
Name:MODES, BRIANA (RN)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:MODES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:SOUTHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34441 8 MILE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4013
Mailing Address - Country:US
Mailing Address - Phone:734-470-3901
Mailing Address - Fax:734-470-3902
Practice Address - Street 1:34441 8 MILE RD STE 109
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:734-470-3901
Practice Address - Fax:734-470-3902
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704348959163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice