Individual provider · Type 1 NPI
Susan Michelle Moultrie, NURSE PRACTITIONER
Family Nurse Practitioner · Victorville, CA
NPI number
1629352901
Active
Practice location
12830 Hesperia Rd Ste Cde
Victorville, CA 92395-7788
Fax (760) 684-8111
Mailing address
4800 Citrus Ave, Apt 5104
Fontana, CA 92336
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 12560 (CA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1629352901
Susan Michelle Moultrie, NURSE PRACTITIONER's National Provider Identifier is 1629352901, issued on Oct 4, 2011. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Victorville, CA. The record was last updated on Oct 31, 2024.