Provider Demographics
NPI:1245624147
Name:MCMULLEN, NICOLE G (MA, RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:G
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DORSET DOCK RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4347
Mailing Address - Country:US
Mailing Address - Phone:732-451-4438
Mailing Address - Fax:
Practice Address - Street 1:1500 DORSET DOCK RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4347
Practice Address - Country:US
Practice Address - Phone:732-451-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1040737133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered