MEDICARE: MRS. DONNA JO CAMP R.D., C.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	37000013A	IN

General Provider Information

NPI Number	:	1275743585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA JO CAMP R.D., C.D.

Provider Business Mailing Address
First Line	:	1820 BAYARD PARK DR
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-2126
Country	:	US
Telephone Number	:	812-473-2960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 BAYARD PARK DR
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-2126
Country	:	US
Telephone Number	:	812-473-2960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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