Provider Demographics
NPI:1407038144
Name:MCNULTY, KAREN M (RD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:MCNULTY
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 1:37 CATHERINE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2776
Mailing Address - Country:US
Mailing Address - Phone:401-619-0749
Mailing Address - Fax:
Practice Address - Street 1:37 CATHERINE ST
Practice Address - Street 2:APT 2
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2776
Practice Address - Country:US
Practice Address - Phone:401-619-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00046133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered