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Individual

ANGELLA JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
85 SUMMIT ST, MONROE, NY 10950-2503
(914) 563-4785
Mailing address
PO BOX 1154, NEW YORK, NY 10276-1154
(914) 563-4785

Taxonomy

Speciality
Code
Description
License number
State
133N00000X
Nutritionist
817058
133V00000X
Registered Dietitian
Primary
817058
NJ

Other

Enumeration date
04/04/2018
Last updated
04/04/2018
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