Provider Demographics
NPI:1457855538
Name:MCMULLIN, EMILY CLARE (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CLARE
Last Name:MCMULLIN
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 1:3318 BLAZE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6458
Mailing Address - Country:US
Mailing Address - Phone:585-746-3893
Mailing Address - Fax:
Practice Address - Street 1:3318 BLAZE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6458
Practice Address - Country:US
Practice Address - Phone:585-746-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered