Provider Demographics
NPI:1952788911
Name:MOULTON, AMANDA B (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:MOULTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:199 ROUTE 101
Mailing Address - Street 2:ELLIOT FAMILY MEDICINE AT AMHERST
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-1735
Mailing Address - Country:US
Mailing Address - Phone:603-249-3000
Mailing Address - Fax:603-249-3021
Practice Address - Street 1:199 ROUTE 101
Practice Address - Street 2:ELLIOT FAMILY MEDICINE AT AMHERST
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-1735
Practice Address - Country:US
Practice Address - Phone:603-249-3000
Practice Address - Fax:603-249-3021
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH062906-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily