Provider Demographics
NPI:1629499959
Name:BUSH, JANET (RD, LD, FSD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:RD, LD, FSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 N HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-2286
Mailing Address - Country:US
Mailing Address - Phone:507-825-8682
Mailing Address - Fax:
Practice Address - Street 1:1091 N HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-2286
Practice Address - Country:US
Practice Address - Phone:507-825-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2879133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered