Provider Demographics
NPI:1558973610
Name:MODUGNO, ASHLEY LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNN
Last Name:MODUGNO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:47 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2323
Mailing Address - Country:US
Mailing Address - Phone:860-892-7042
Mailing Address - Fax:
Practice Address - Street 1:47 TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2323
Practice Address - Country:US
Practice Address - Phone:860-892-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily