Healthcare Provider Details

I. General information

NPI: 1871617704
Provider Name (Legal Business Name): KATHLEEN AB BUSBY MS, CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 N 34TH ST SUITE 500
SEATTLE WA
98103-9058
US

IV. Provider business mailing address

3200 E YESLER WAY
SEATTLE WA
98122-6502
US

V. Phone/Fax

Practice location:
  • Phone: 206-251-3411
  • Fax:
Mailing address:
  • Phone: 206-251-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU00001804
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: