Individual
JENNA MARIE MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
535 E 70TH ST, NEW YORK, NY 10021-4898
(212) 606-1253
Mailing address
241 N TERRY HILL RD, CARMEL, NY 10512-5229
(716) 983-9603
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
382529
NY
Other
Enumeration date
03/25/2015
Last updated
04/26/2021
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