Individual
MRS. SUSAN L MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
2284 S BALLENGER HWY, SUITE H, FLINT, MI 48503-3446
(810) 233-5211
Mailing address
2284 S BALLENGER HWY, SUITE H, FLINT, MI 48503-3446
(810) 233-5211
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
4704104617
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4416010
—
MI
01
—
5008767180
BCBS ID
MI
01
—
OM32030
MEDICARE GROUP
MI
Enumeration date
02/01/2007
Last updated
01/06/2016
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