Provider Demographics
NPI:1144098625
Name:BUIA, JACQUELINE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BUIA
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01831-0882
Mailing Address - Country:US
Mailing Address - Phone:978-479-7488
Mailing Address - Fax:
Practice Address - Street 1:272 KENOZA ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4319
Practice Address - Country:US
Practice Address - Phone:978-479-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered