Individual
TRACIE MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 ROUTE 130, FORESTDALE, MA 02644-1402
(508) 477-5306
(508) 477-0297
Mailing address
55 ROUTE 130, P O BOX 549, FORESTDALE, MA 02644-1402
(508) 477-5306
(508) 477-0297
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024170590
VA
Other
Enumeration date
01/28/2013
Last updated
08/02/2016
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