Provider Demographics
NPI:1063541209
Name:MULLIGAN, KATIE THERESE (RD)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:THERESE
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 NARRAGANSETT PKWY
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-4814
Mailing Address - Country:US
Mailing Address - Phone:401-952-2934
Mailing Address - Fax:
Practice Address - Street 1:828 NARRAGANSETT PKWY
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-4814
Practice Address - Country:US
Practice Address - Phone:401-952-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered