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Individual

BERTILLE OCTAVIE MAVEGAM TANGO ASSOUMOU M

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
22 ATWOOD DR FL 1, NORTHAMPTON, MA 01060-4267
(413) 586-1601
(413) 923-9304
Mailing address
22 ATWOOD DR FL 1, NORTHAMPTON, MA 01060-4267
(413) 586-1601
(413) 923-9304

Taxonomy

Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary

Other

Enumeration date
08/23/2016
Last updated
08/23/2016
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