Provider Demographics
NPI:1891065751
Name:BUZINSKI, ELISA MARIE (MS RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:MARIE
Last Name:BUZINSKI
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 N 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3637
Mailing Address - Country:US
Mailing Address - Phone:708-205-2772
Mailing Address - Fax:
Practice Address - Street 1:820 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1351
Practice Address - Country:US
Practice Address - Phone:708-524-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered