Provider Demographics
NPI:1790015386
Name:KEARNS FITZGERALD, CHRISTINA (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KEARNS FITZGERALD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 N HOYNE AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5553
Mailing Address - Country:US
Mailing Address - Phone:847-340-4463
Mailing Address - Fax:773-409-5699
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:847-340-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL941317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered