Active NPI
Faith Genevieve Fude, MS, RD, LD
- Registered Dietitian
- Fairview Heights, IL
National Provider Identifier
1497593339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 226416
- Practice address
- 63 Broadstone Dr
Fairview Heights, IL 62208-1059 - Phone
- (630) 632-5408
- NPI assigned
- Jul 16, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 226416 | AK | Primary |
Addresses
Primary practice location
63 Broadstone Dr
Fairview Heights, IL 62208-1059
Mailing address
63 Broadstone Dr
Fairview Heights, IL 62208-1059
Phone (630) 632-5408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 226416 | AK | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1497593339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 BROADSTONE DR",
"city": "FAIRVIEW HEIGHTS",
"state": "IL",
"postal_code": "622081059",
"telephone_number": "630-632-5408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 BROADSTONE DR",
"city": "FAIRVIEW HEIGHTS",
"state": "IL",
"postal_code": "622081059",
"telephone_number": "630-632-5408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUDE",
"first_name": "FAITH",
"middle_name": "GENEVIEVE",
"credential": "MS, RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-16",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AK",
"license": "226416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairview Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.