Provider Demographics
NPI:1295181279
Name:CULLEN, CHRISTINE (RD CDE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2324
Mailing Address - Country:US
Mailing Address - Phone:617-680-4141
Mailing Address - Fax:
Practice Address - Street 1:20 MAPLE CT
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2324
Practice Address - Country:US
Practice Address - Phone:617-680-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered