MEDICARE: KATHERINE G MULLIN RD, CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI713	ME

General Provider Information

NPI Number	:	1619924107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE G MULLIN RD, CDE

Provider Business Mailing Address
First Line	:	7 FARWELL AVE
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-4002
Country	:	US
Telephone Number	:	207-939-9259
Fax Number	:	207-828-7850

Provider Business Practice Location Address
First Line	:	7 FARWELL AVE
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-4002
Country	:	US
Telephone Number	:	207-939-9259
Fax Number	:	207-828-7850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/21/2025

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