Provider Demographics
NPI:1114443827
Name:BUECHNER, JUDITH MARIE (RD, CD, LDN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
Last Name:BUECHNER
Suffix:
Gender:F
Credentials:RD, CD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 E RACINE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-5225
Mailing Address - Country:US
Mailing Address - Phone:608-215-6620
Mailing Address - Fax:
Practice Address - Street 1:2520 E RACINE ST APT 4
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-5225
Practice Address - Country:US
Practice Address - Phone:608-215-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered