Individual
SHANTA MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 LOCKPORT ST APT 315, BISMARCK, ND 58503-5581
(815) 735-7322
Mailing address
4001 LOCKPORT ST APT 315, BISMARCK, ND 58503-5581
(815) 735-7322
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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