| Doctor Name: | LILLYKUTTY A MODOOR |
| NPI Number: | 1013155969 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 5004280 |
| Business Practice Address: | 3333 Silas Creek Pkwy Winston Salem, NC - 271033013 |
| Business Phone Number: | 3362771800 |
| Business Fax Number: | 3362776981 |
| Mailing Address: | Po Box 60447, CHARLOTTE |
| State: | NC |
| Postal Code: | 282600447 |
| Phone Number: | 3362771800 |
| Fax Number: | 3362776981 |
| NPI Enumeration Date: | 01/30/2009 |
| NPI Last Update Date: | 07/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5004280 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |