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General NPI Number Information
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NPI Number | 1376070615
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Entity Type | Organization
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Legal Business Name | DIETITIANCARE, LLC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 05/17/2017
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Provider Practice Location Address
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Address Line | 1775 S BASSWOOD TRL
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City | LA PORTE
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State | IN
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Zip | 46350-9289
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Country | US
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Telephone | 219-309-1577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2621
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City | CHESTERTON
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State | IN
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Zip | 46304
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Country | US
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Telephone | 219-309-1577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDITH M FITZHUGH
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Credential | RDN
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Telephone | 219-309-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 79000014A
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1640045A
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 37000345A
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License Number State | IN
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