Provider Demographics
NPI:1396391728
Name:MODOS, BRIANN N (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIANN
Middle Name:N
Last Name:MODOS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 GRAND TETON PLZ STE 220
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1048
Mailing Address - Country:US
Mailing Address - Phone:608-713-9898
Mailing Address - Fax:608-713-9647
Practice Address - Street 1:6515 GRAND TETON PLZ STE 220
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1048
Practice Address - Country:US
Practice Address - Phone:608-713-9898
Practice Address - Fax:608-713-9647
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI218791-30163WP0809X
WI9370-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult