Basic Information
| Provider Information | |||||||||
| NPI: | 1780391318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUWES-CAMPOS | ||||||||
| FirstName: | KATJA | ||||||||
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| OtherLastName: | DOUWES | ||||||||
| OtherFirstName: | KATJA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7531 E RAMBLEWOOD ST | ||||||||
| Address2: | |||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983668442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064223244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2508 WHEATON WAY | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2022 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI61215759 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.