Jennifer Modliszewski

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN2274129 Issued in MA

Practice address

1611 Cambridge St
Cambridge, MA 02138-4302

Phone

(617) 661-5500

NPI assigned

Dec 28, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1659617207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021384302",
            "telephone_number": "931-980-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021384302",
            "telephone_number": "617-661-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 Columbia Rd",
            "address_purpose": "LOCATION",
            "city": "Dorchester",
            "state": "MA",
            "postal_code": "021252424",
            "country_code": "US",
            "telephone_number": "617-287-8000 x8172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODLISZEWSKI",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-28",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2274129",
            "primary": true
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MA",
            "license": "2274129",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Moallem
• Mahmoud Ahmed Moawad Elnaa, M.D.
• Mobile-Med Work Health Solutions, Inc.
• Andrew P Modest, M.D.
• Leslie A Modlin, M.D.
• Shobana Raghuram Modur
• Brigitte Moeller, MSW, LICSW
• Rafaela Mogauro, DONA
• Justine Jessa Mohaddess-Westmoreland, PSYD
• Jose M Molinar, M.D.

• Adult Health Nurse Practitioner in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Adult Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.