Provider Demographics
NPI:1780391318
Name:DOUWES-CAMPOS, KATJA
Entity type:Individual
Prefix:
First Name:KATJA
Middle Name:
Last Name:DOUWES-CAMPOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATJA
Other - Middle Name:
Other - Last Name:DOUWES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7531 E RAMBLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8442
Mailing Address - Country:US
Mailing Address - Phone:206-422-3244
Mailing Address - Fax:
Practice Address - Street 1:2508 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61215759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered