Provider Demographics
NPI:1922685023
Name:FABLE, NATASHA SEMENTA (MD, MPH, MS)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:SEMENTA
Last Name:FABLE
Suffix:
Gender:F
Credentials:MD, MPH, MS
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:SEMENTA
Other - Last Name:FABLE ONDAAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH, CPH
Mailing Address - Street 1:815 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1080
Mailing Address - Country:US
Mailing Address - Phone:309-672-4984
Mailing Address - Fax:
Practice Address - Street 1:815 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1080
Practice Address - Country:US
Practice Address - Phone:309-672-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.170235207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program