Healthcare Provider Details

I. General information

NPI: 1588838833
Provider Name (Legal Business Name): JUDY ANNE BUSCH R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N DELAWARE ST
INDIANAPOLIS IN
46280-1348
US

IV. Provider business mailing address

10210 N DELAWARE ST
INDIANAPOLIS IN
46280-1348
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-9813
  • Fax:
Mailing address:
  • Phone: 317-848-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number37000091A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: