Provider Demographics
NPI:1134956360
Name:RUSU, DENISE (RDN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RUSU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 BEREAN RD
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:TX
Mailing Address - Zip Code:76557-3922
Mailing Address - Country:US
Mailing Address - Phone:469-744-4616
Mailing Address - Fax:
Practice Address - Street 1:394 BEREAN RD
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:TX
Practice Address - Zip Code:76557-3922
Practice Address - Country:US
Practice Address - Phone:469-744-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90981133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered