Provider Demographics
NPI:1770118622
Name:GACEK, BROOKE (RDN, LD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GACEK
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:2889 SOLLIE RD APT 303
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-5535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD STE A101
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6767
Practice Address - Country:US
Practice Address - Phone:251-633-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3114133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered