Provider Demographics
NPI:1891302006
Name:MCNULTY, ALLISON MARIE (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 E MLK JR BLVD APT 2329
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-0038
Mailing Address - Country:US
Mailing Address - Phone:978-852-2200
Mailing Address - Fax:
Practice Address - Street 1:2823 E MLK JR BLVD APT 2329
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-0038
Practice Address - Country:US
Practice Address - Phone:978-852-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86072603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered