Provider Demographics
NPI:1275743585
Name:CAMP, DONNA JO (RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JO
Last Name:CAMP
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 BAYARD PARK DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2126
Mailing Address - Country:US
Mailing Address - Phone:812-473-2960
Mailing Address - Fax:
Practice Address - Street 1:1820 BAYARD PARK DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2126
Practice Address - Country:US
Practice Address - Phone:812-473-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000013A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered