Individual
MR. WALTER JOHN MOULAISON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
55 FRUIT ST, CLINICS BUILDING 144, BOSTON, MA 02114-2621
(617) 726-2577
Mailing address
13 MANOR DR, PEABODY, MA 01960-2057
(978) 535-7084
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
161307
MA
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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