Individual
AUDREY MARCOUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
10708 N GAGE RD, BARNEVELD, NY 13304-2527
(315) 896-2654
(315) 896-2717
Mailing address
1020 MARY ST, UTICA, NY 13501-1930
(315) 724-6907
(315) 733-0791
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000901
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000901
LICENSE
NY
Enumeration date
04/12/2016
Last updated
04/12/2016
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