Provider Demographics
NPI:1407220387
Name:BUSCH, HOLLIS ANN (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:HOLLIS
Middle Name:ANN
Last Name:BUSCH
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2422
Mailing Address - Country:US
Mailing Address - Phone:716-773-1029
Mailing Address - Fax:
Practice Address - Street 1:1029 W RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2422
Practice Address - Country:US
Practice Address - Phone:716-773-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered