Healthcare Provider Details

I. General information

NPI: 1760881536
Provider Name (Legal Business Name): PATRICIA MCHUGH RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W SAINT ANTHONY AVE
EFFINGHAM IL
62401-2027
US

IV. Provider business mailing address

705 BENT TREE DR
EFFINGHAM IL
62401-3159
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-2085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1079141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: