Provider Demographics
NPI:1386179786
Name:BUSA, KATHLEEN (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:
Last Name:BUSA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2338
Mailing Address - Country:US
Mailing Address - Phone:781-276-1773
Mailing Address - Fax:
Practice Address - Street 1:65 WIGGINS AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2338
Practice Address - Country:US
Practice Address - Phone:781-276-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered