Provider Demographics
NPI:1316318876
Name:CHMIEL, STACEY (MS,RD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CHMIEL
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COUNTY ROAD 1280
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:TX
Mailing Address - Zip Code:76671-3066
Mailing Address - Country:US
Mailing Address - Phone:217-246-1000
Mailing Address - Fax:
Practice Address - Street 1:211 COUNTY ROAD 1280
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:TX
Practice Address - Zip Code:76671-3066
Practice Address - Country:US
Practice Address - Phone:217-246-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83221133V00000X
TX1062475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered