Provider Demographics
NPI:1336779677
Name:HATFIELD, LYDIA G (RD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:G
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:GRACE
Other - Last Name:LITWILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2401 W. UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303
Mailing Address - Country:US
Mailing Address - Phone:765-747-3345
Mailing Address - Fax:
Practice Address - Street 1:2401 W. UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303
Practice Address - Country:US
Practice Address - Phone:765-747-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1091280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered