Provider Demographics
NPI:1619924107
Name:MULLIN, KATHERINE G (RD, CDE)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:MULLIN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7 FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-4002
Mailing Address - Country:US
Mailing Address - Phone:207-939-9259
Mailing Address - Fax:207-828-7850
Practice Address - Street 1:15 SKY VIEW DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1339
Practice Address - Country:US
Practice Address - Phone:207-781-4922
Practice Address - Fax:207-781-4925
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT014804Medicare PIN