Individual
MS. CHARLOTTE ELISE MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAILCODE UHS-2, PORTLAND, OR 97239-3098
(503) 494-4910
(503) 494-8368
Mailing address
8837 SE TAYLOR ST, PORTLAND, OR 97216-1738
(954) 655-2574
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200660031CRNA
OR
Other
Enumeration date
07/24/2006
Last updated
10/28/2020
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