Provider Demographics
NPI:1790544641
Name:MULLEN, LEE (RDN,LD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:RDN,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17149 OPAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9156
Mailing Address - Country:US
Mailing Address - Phone:303-523-2147
Mailing Address - Fax:
Practice Address - Street 1:939 N CANYON DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9271
Practice Address - Country:US
Practice Address - Phone:303-523-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered