Active NPI
Walter John Moulaison Jr., RN
- Administrator Registered Nurse
- Boston, MA
National Provider Identifier
1972651735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 161307
- Practice address
- 55 Fruit St
Clinics Building 144
Boston, MA 02114-2621 - Phone
- (617) 726-2577
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 161307 | MA | Primary |
Addresses
Primary practice location
55 Fruit St
Clinics Building 144
Boston, MA 02114-2621
Mailing address
13 Manor Dr
Peabody, MA 01960-2057
Phone (978) 535-7084
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 161307 | MA | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972651735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 MANOR DR",
"city": "PEABODY",
"state": "MA",
"postal_code": "019602057",
"telephone_number": "978-535-7084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FRUIT ST",
"address_2": "CLINICS BUILDING 144",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142621",
"telephone_number": "617-726-2577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULAISON",
"first_name": "WALTER",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "MA",
"license": "161307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.