Provider Demographics
NPI:1972386597
Name:MOULTON, SHAWNA V
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:V
Last Name:MOULTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:GLYNN
Other - Last Name:VOLLMERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21007 LONELY STAR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7045
Mailing Address - Country:US
Mailing Address - Phone:281-633-6891
Mailing Address - Fax:
Practice Address - Street 1:21007 LONELY STAR LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7045
Practice Address - Country:US
Practice Address - Phone:281-633-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach