Provider Demographics
NPI:1588643886
Name:MOULTON, CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MOULTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S LUBEC RD
Mailing Address - Street 2:
Mailing Address - City:LUBEC
Mailing Address - State:ME
Mailing Address - Zip Code:04652-3620
Mailing Address - Country:US
Mailing Address - Phone:207-733-5541
Mailing Address - Fax:207-733-2127
Practice Address - Street 1:43 S LUBEC RD
Practice Address - Street 2:
Practice Address - City:LUBEC
Practice Address - State:ME
Practice Address - Zip Code:04652-3620
Practice Address - Country:US
Practice Address - Phone:207-733-5541
Practice Address - Fax:207-733-2127
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME035412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME247370099Medicaid
MENP2592Medicare ID - Type UnspecifiedMEDICARE
ME247370099Medicaid
ME500014763Medicare PIN
MEP12140Medicare UPIN