Healthcare Provider Details

I. General information

NPI: 1326662511
Provider Name (Legal Business Name): DEVIN LEEANN BUSS MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

IV. Provider business mailing address

2701 HOMESTEAD RD APT 811
CHAPEL HILL NC
27516-8757
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-1264
  • Fax:
Mailing address:
  • Phone: 404-434-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: