Individual
MS. PAMELA FAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
2200 E DEVON AVE STE 309, DES PLAINES, IL 60018-4505
(847) 708-4929
Mailing address
8325 S HERMITAGE AVE, CHICAGO, IL 60620-4630
(949) 394-1064
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164003018
IL
Other
Enumeration date
07/13/2014
Last updated
07/13/2014
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