Anick Diessongo, is a
Dietitian, Registered based in Scott Air Force Base, Illinois. Anick Diessongo is licensed to practice in Illinois (license number 164009254) and her current practice location is
4711 Thomas Jefferson Cir Apt A, Scott Air Force Base, Illinois. She can be reached at her office (for appointments etc.) via phone at
(646) 288-5143.
NPI number for Anick Diessongo is 1780463059 and her current mailing address is 19310 Wildcat Trl, Davidson, North Carolina. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1780463059.
Healthcare Provider's Profile
| Full Name | Anick Diessongo |
|---|
| Gender | Female |
|---|
| Speciality | Dietitian, Registered |
|---|
| Location | 4711 Thomas Jefferson Cir Apt A, Scott Air Force Base, Illinois |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1780463059
- Provider Enumeration Date: 09/26/2023
- Last Update Date: 09/26/2023
Medical Identifiers
Medical identifiers for Anick Diessongo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1780463059 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 133V00000X | Dietitian, Registered | 164009254 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Anick Diessongo is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Anick Diessongo, 19310 Wildcat Trl, Davidson, NC 28036-8882 Ph: Not Available | Anick Diessongo, 4711 Thomas Jefferson Cir Apt A, Scott Air Force Base, IL 62225-6225 Ph: (646) 288-5143 |
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