Provider Demographics
NPI:1114954112
Name:MCMULLIN-FIELD, CAROLE (RD)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:MCMULLIN-FIELD
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-3500
Mailing Address - Fax:314-230-1119
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM ENDOCRINOLOGY, STE 13B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3500
Practice Address - Fax:314-230-1119
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016958133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO350966701Medicaid