Provider Demographics
NPI:1053941088
Name:IRVINE, CAMILLE WOOLF (MS, RDN)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:WOOLF
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 FAWN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49344-9780
Mailing Address - Country:US
Mailing Address - Phone:616-916-2475
Mailing Address - Fax:
Practice Address - Street 1:5419 FAWN LAKE DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:MI
Practice Address - Zip Code:49344-9780
Practice Address - Country:US
Practice Address - Phone:616-916-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered