Provider Demographics
NPI:1770190985
Name:POULTON, CHRISTINE R
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:POULTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1218
Mailing Address - Country:US
Mailing Address - Phone:609-682-0032
Mailing Address - Fax:
Practice Address - Street 1:814 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-1218
Practice Address - Country:US
Practice Address - Phone:609-682-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor