Individual
SIRI MAMOUNGE FOBANJONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
235 WELLESLEY ST, WESTON, MA 02493-1571
(508) 685-3516
Mailing address
27 EDDY DR, WESTPORT, MA 02790-1931
(508) 685-3516
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2261316
MA
Other
Enumeration date
07/18/2023
Last updated
07/20/2023
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