Provider Demographics
NPI:1255648457
Name:BUUCK, ANGELA MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:BUUCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 COUNTY ROAD 64
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9620
Mailing Address - Country:US
Mailing Address - Phone:260-849-9443
Mailing Address - Fax:
Practice Address - Street 1:2690 COUNTY ROAD 64
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-9620
Practice Address - Country:US
Practice Address - Phone:260-849-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000831A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400026318Medicare PIN
INM400026317Medicare PIN
INM400025902Medicare PIN
INM400026316Medicare PIN