Provider Demographics
NPI:1912150012
Name:MOULTON, ADELE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:
Last Name:MOULTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3022
Mailing Address - Country:US
Mailing Address - Phone:914-699-3888
Mailing Address - Fax:
Practice Address - Street 1:20 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3022
Practice Address - Country:US
Practice Address - Phone:914-699-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219870164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse