Provider Demographics
NPI:1962643692
Name:MODI, BATHSHEBA ANNA
Entity Type:Individual
Prefix:
First Name:BATHSHEBA
Middle Name:ANNA
Last Name:MODI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BATHSHEBA
Other - Middle Name:ANNA
Other - Last Name:FILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:16041 CADDIE CT
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-9583
Mailing Address - Country:US
Mailing Address - Phone:910-369-2010
Mailing Address - Fax:
Practice Address - Street 1:16041 CADDIE CT
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396-9583
Practice Address - Country:US
Practice Address - Phone:910-369-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC155951163W00000X
NY3795391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse