Healthcare Provider Details

I. General information

NPI: 1619924107
Provider Name (Legal Business Name): KATHERINE G MULLIN RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE GILL R.D.

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FARWELL AVE
CUMBERLAND ME
04021-4002
US

IV. Provider business mailing address

7 FARWELL AVE
CUMBERLAND ME
04021-4002
US

V. Phone/Fax

Practice location:
  • Phone: 207-939-9259
  • Fax: 207-828-7850
Mailing address:
  • Phone: 207-939-9259
  • Fax: 207-828-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI713
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: