Provider Demographics
NPI:1578003091
Name:DUCASSE, OLIVIA (ND)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DUCASSE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1128
Mailing Address - Country:US
Mailing Address - Phone:207-647-5944
Mailing Address - Fax:
Practice Address - Street 1:82 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1128
Practice Address - Country:US
Practice Address - Phone:207-647-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education