Wanda Kay Moulson
Technician, Attendant Care Provider in Fort Mill, SC. Individual provider (NPI-1).
NPI number1164078622
StatusActive
Last updated in NPPESAug 12, 2019
Details
- NPI
- 1164078622
- Entity type
- Individual (NPI-1)
- Name
- Wanda Kay Moulson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 12, 2019
- Last updated
- Aug 12, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747A0650X | Technician, Attendant Care Provider | – | – | Yes |
Practice location
2713 Dunlin DrFort Mill, SC 29707-9118
Phone 804-350-9162
Mailing address
2713 Dunlin DrFort Mill, SC 29707-9118
Phone 804-350-9162
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