Doctor Name: | MS. PAMELA FAGEN |
NPI Number: | 1790192698 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | REGISTERED DIETITIAN |
License Number: | 164003018 |
Business Practice Address: | 2200 E Devon Ave Ste 309 Des Plaines, IL - 600184505 |
Business Phone Number: | 8477084929 |
Business Fax Number: | |
Mailing Address: | 8325 S Hermitage Ave, CHICAGO |
State: | IL |
Postal Code: | 606204630 |
Phone Number: | 9493941064 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2014 |
NPI Last Update Date: | 07/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 164003018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |