Provider Demographics
NPI:1962283044
Name:MOULTON, SAMANTHA (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MOULTON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-247-7420
Mailing Address - Fax:856-247-7421
Practice Address - Street 1:1945 ROUTE 70 E STE A
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2160
Practice Address - Country:US
Practice Address - Phone:856-247-7420
Practice Address - Fax:856-247-7421
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DELG-0012524363L00000X
NJ26NJ15311700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner