NPIMap

Judith Marie Fitzhugh, RDN, CDE, LDN, CD

Individual provider Active NPI Registered Dietitian · Laporte, IN

NPI 1114460102 · NPPES record last updated Jan 19, 2018

Key facts

NPI
1114460102
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
CDR#836541
Practice address
1775 S. Basswood Trail
Laporte, IN 46350
Phone
(219) 309-1577
NPI assigned
Nov 23, 2016
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1640045AILMDRegistered Dietitian
37000345AINMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Dietitiancare, LLC Dietitian, Registered Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 37000345A IN
Registered Dietitian 133V00000X 1640045A IL
Registered Dietitian 133V00000X CDR#836541 Yes

Addresses

Primary practice location

1775 S. Basswood Trail
Laporte, IN 46350

Mailing address

1775 S. Basswood Trail
Laporte, IN 46350
Phone (219) 309-1577

Other providers in Laporte, IN

All providers in Laporte, IN · Registered Dietitian in Indiana

Sources for this page

Verify at the official NPI Registry.