Provider Demographics
NPI:1104000207
Name:HALL MOULTON, SHIRLEY LORRAINE (PHN RN MPHA)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:LORRAINE
Last Name:HALL MOULTON
Suffix:
Gender:F
Credentials:PHN RN MPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 I STREET
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1116
Mailing Address - Country:US
Mailing Address - Phone:707-268-2105
Mailing Address - Fax:707-445-6091
Practice Address - Street 1:529 I STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1116
Practice Address - Country:US
Practice Address - Phone:707-268-2105
Practice Address - Fax:707-445-6091
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN171646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse