Individual
MRS. JODI ANNE FULAYTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2902 CAMPBELL ST, JOLIET, IL 60435-6492
(708) 261-3463
(815) 744-2707
Mailing address
2902 CAMPBELL ST, JOLIET, IL 60435-6492
(708) 261-3463
(815) 744-2707
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
164003007
IL
133V00000X
Registered Dietitian
Primary
164003007
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09932114
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/05/2007
Last updated
08/09/2023
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