Provider Demographics
NPI:1093956609
Name:MODESTINO, PATRICIA G (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:MODESTINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1466
Mailing Address - Fax:610-973-1442
Practice Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2351
Practice Address - Country:US
Practice Address - Phone:610-973-1466
Practice Address - Fax:610-973-1442
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily