Provider Demographics
NPI:1114460102
Name:FITZHUGH, JUDITH MARIE (RDN, CDE, LDN, CD)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARIE
Last Name:FITZHUGH
Suffix:
Gender:F
Credentials:RDN, CDE, LDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 S. BASSWOOD TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350
Mailing Address - Country:US
Mailing Address - Phone:219-309-1577
Mailing Address - Fax:
Practice Address - Street 1:1775 S. BASSWOOD TRAIL
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-309-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000345A133V00000X
IL1640045A133V00000X
CDR#836541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered