Provider Demographics
NPI:1629726617
Name:FABRE, CHANTELLE ALISE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:ALISE
Last Name:FABRE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CEDAR CREEK LN APT 4012
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2350
Mailing Address - Country:US
Mailing Address - Phone:225-240-3409
Mailing Address - Fax:
Practice Address - Street 1:2700 CEDAR CREEK LN APT 4012
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-2350
Practice Address - Country:US
Practice Address - Phone:225-240-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87604133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered