Provider Demographics
NPI:1780042028
Name:BUSS, PATRICIA (RD, CD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BUSS
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S KUESTER LN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-2558
Mailing Address - Country:US
Mailing Address - Phone:262-323-9176
Mailing Address - Fax:
Practice Address - Street 1:640 S KUESTER LN
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-2558
Practice Address - Country:US
Practice Address - Phone:262-323-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01030822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered