Healthcare Provider Details

I. General information

NPI: 1922058742
Provider Name (Legal Business Name): JUDITH ANN OGARA LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL GREAT LAKES 3001A 6TH STREET BLDG 200H
GREAT LAKES IL
60088-2811
US

IV. Provider business mailing address

740 LARAMIE AVE
WILMETTE IL
60091-2052
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-3446
  • Fax:
Mailing address:
  • Phone: 847-688-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: