Provider Demographics
NPI:1063450955
Name:BUSSE, KRISTINA A (RD CD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:BUSSE
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:GROSHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 WESTHILL DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 WESTHILL DR
Practice Address - Street 2:SUITE 303
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3795
Practice Address - Country:US
Practice Address - Phone:715-847-2304
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1592133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered