Provider Demographics
NPI:1396592051
Name:NICOLE MCMULLEN NUTRITION LLC
Entity type:Organization
Organization Name:NICOLE MCMULLEN NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:732-451-4438
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty