Provider Demographics
NPI:1952607939
Name:MCMULLEN, MONICA LEE (RD, CD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 WEST MICHIGAN ST.
Mailing Address - Street 2:WESTSIDE HEALTH CENTER
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222
Mailing Address - Country:US
Mailing Address - Phone:317-554-4607
Mailing Address - Fax:317-554-4617
Practice Address - Street 1:2732 WEST MICHIGAN ST.
Practice Address - Street 2:WESTSIDE HEALTH CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222
Practice Address - Country:US
Practice Address - Phone:317-554-4607
Practice Address - Fax:317-554-4617
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002087A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered