Provider Demographics
NPI:1871617704
Name:BUSBY, KATHLEEN AB (MS, CN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:AB
Last Name:BUSBY
Suffix:
Gender:F
Credentials:MS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E YESLER WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6502
Mailing Address - Country:US
Mailing Address - Phone:206-251-3411
Mailing Address - Fax:
Practice Address - Street 1:1914 N 34TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9058
Practice Address - Country:US
Practice Address - Phone:206-251-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001804133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education