Provider Demographics
NPI:1639480957
Name:BUSH-ZOLECKI, DONNA LYNN (RD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:BUSH-ZOLECKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E ROOSEVELT ROAD,
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5200
Mailing Address - Country:US
Mailing Address - Phone:630-752-8823
Mailing Address - Fax:630-480-0057
Practice Address - Street 1:104 E ROOSEVELT ROAD,
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5200
Practice Address - Country:US
Practice Address - Phone:630-752-8823
Practice Address - Fax:630-480-0057
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-000503133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered