Healthcare Provider Details

I. General information

NPI: 1669563946
Provider Name (Legal Business Name): JENNIFER L MULLER RDN,LDN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 N CHARLES ST STE 125
BALTIMORE MD
21204-5822
US

IV. Provider business mailing address

PO BOX 631568
BALTIMORE MD
21263-1568
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-3793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2437
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: