Provider Demographics
NPI:1992910343
Name:HARDIN, CAMILLA (RD, CD, LD)
Entity type:Individual
Prefix:MS
First Name:CAMILLA
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:RD, CD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 S 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2903
Mailing Address - Country:US
Mailing Address - Phone:414-389-9671
Mailing Address - Fax:
Practice Address - Street 1:2808 S 68TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2903
Practice Address - Country:US
Practice Address - Phone:414-389-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist