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Individual
DONALD E MOULTON
Active
Individual
DONALD E MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN OTC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
083026191RN
OR
163WX0800X
Orthopedic Registered Nurse
930064
OR
374700000X
Technician
Primary
930064 OT-SC
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
GROUP NPI NUMBER
OR
01
—
930635514
GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
02/23/2007
Last updated
03/23/2010
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