Individual
ANICK DIESSONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4711 THOMAS JEFFERSON CIR APT A, SCOTT AIR FORCE BASE, IL 62225-6225
(646) 288-5143
Mailing address
19310 WILDCAT TRL, DAVIDSON, NC 28036-8882
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164009254
IL
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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