Provider Demographics
NPI:1710433461
Name:BUSSERT, JOYCE PREMIKA (RDN, LDN, MPH)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:PREMIKA
Last Name:BUSSERT
Suffix:
Gender:F
Credentials:RDN, LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WASDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3928
Mailing Address - Country:US
Mailing Address - Phone:224-334-2287
Mailing Address - Fax:
Practice Address - Street 1:650 E ALGONQUIN RD STE 108
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-3853
Practice Address - Country:US
Practice Address - Phone:224-334-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered