MEDICARE: CHANEL MARIE CHAGNARD RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	2760	LA
2	133V00000X	Registered Dietitian	2760	LA

General Provider Information

NPI Number	:	1508388174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL MARIE CHAGNARD RDN, LDN

Provider Business Mailing Address
First Line	:	6000 BRIGHTON PL
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-4030
Country	:	US
Telephone Number	:	504-906-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	9531 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70123-2507
Country	:	US
Telephone Number	:	504-715-2317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	03/17/2018

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