Provider Demographics
NPI:1093086092
Name:LUDGATE, MARIE (RD, LD, LDN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LUDGATE
Suffix:
Gender:F
Credentials:RD, LD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DEVILS GLEN RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3363
Mailing Address - Country:US
Mailing Address - Phone:563-349-2757
Mailing Address - Fax:
Practice Address - Street 1:2900 DEVILS GLEN RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3363
Practice Address - Country:US
Practice Address - Phone:563-349-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001995133V00000X
IA001995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered