Provider Demographics
NPI:1588623573
Name:MODLIN-ADAMS, CYNTHIA J (RN MSN ANP BC BYANCC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:J
Last Name:MODLIN-ADAMS
Suffix:
Gender:F
Credentials:RN MSN ANP BC BYANCC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:MODLIN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1501 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2134
Mailing Address - Country:US
Mailing Address - Phone:765-446-4838
Mailing Address - Fax:765-446-4851
Practice Address - Street 1:1501 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2134
Practice Address - Country:US
Practice Address - Phone:765-446-4838
Practice Address - Fax:765-446-4851
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRN28084777A363L00000X
INNP71000092A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397607OtherPHCS PID NUMBER
IN200941060Medicaid
IN000000559485OtherANTHEM
IN500006273OtherRAILROAD MEDICARE
IN500006273OtherRAILROAD MEDICARE
IN000000559485OtherANTHEM
IN500006273OtherRAILROAD MEDICARE