Healthcare Provider Details

I. General information

NPI: 1144505199
Provider Name (Legal Business Name): ISABELLE FAUCHER RD LD CSR CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 EXECUTIVE DR UNIT 103
NAPLES FL
34119
US

IV. Provider business mailing address

4522 EXECUTIVE DR UNIT 103
NAPLES FL
34119
US

V. Phone/Fax

Practice location:
  • Phone: 954-464-5839
  • Fax:
Mailing address:
  • Phone: 954-464-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND2784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: