Provider Demographics
NPI:1093034902
Name:MULLEN, JESSICA MADISON (RD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MADISON
Last Name:MULLEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4315
Mailing Address - Country:US
Mailing Address - Phone:206-851-2037
Mailing Address - Fax:
Practice Address - Street 1:741 N 81ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4315
Practice Address - Country:US
Practice Address - Phone:206-851-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA967193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered