Lillykutty A Modoor
Nurse Practitioner Nurse Practitioner - Family Medicine Nurse Practitioner - Psychiatric/Mental Health
650 Highland Ave Ste 100
Winston Salem
, North Carolina 27101-4304
Lillykutty A Modoor
Nurse Practitioner Nurse Practitioner - Family Medicine Nurse Practitioner - Psychiatric/Mental Health
650 Highland Ave Ste 100
Winston Salem
, North Carolina 27101-4304
(336) 277-6981
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About
Features
Specialties
- Nurse Practitioner
- Nurse Practitioner - Family Medicine
- Nurse Practitioner - Psychiatric/Mental Health
Languages spoken
- English
Location
First Address
- Lillykutty A Modoor
- Po Box 60447
- Charlotte, NC
- Zip : 28260-0447
- Fax : (336) 277-6981
- Phone : (336) 277-1800
Second Address
- Lillykutty A Modoor
- 650 Highland Ave Ste 100
- Winston Salem, NC
- Zip : 27101-4304
- Fax : (336) 773-0916
- Phone : (336) 607-8523
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 5004280 | NC |
| N | 363LF0000X | Nurse Practitioner - Family Medicine | 5004280 | NC |
| Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5004280 | NC |
National Provider Identifier
| NPI | 1013155969 |
|---|---|
| Provider Name | Lillykutty A Modoor |
| First Address | Charlotte, NC 28260-0447 |
| Second Address | Winston Salem, NC 27101-4304 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/01/2009 |
| Last Update Date | 02/12/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.