Provider Demographics
NPI:1083000210
Name:DE BUZNA, JANELLE A (MS, RD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:A
Last Name:DE BUZNA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 E CHAUNCEY LN
Mailing Address - Street 2:APT 1025
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5101
Mailing Address - Country:US
Mailing Address - Phone:720-771-8449
Mailing Address - Fax:
Practice Address - Street 1:6901 E CHAUNCEY LN
Practice Address - Street 2:APT 1025
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5101
Practice Address - Country:US
Practice Address - Phone:720-771-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL836793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered