Provider Demographics
NPI:1689490781
Name:DELKAMP, DENISE (DEE DEE) MARIE (CN)
Entity type:Individual
Prefix:
First Name:DENISE (DEE DEE)
Middle Name:MARIE
Last Name:DELKAMP
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3416 BERYL DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-9469
Mailing Address - Country:US
Mailing Address - Phone:920-253-8870
Mailing Address - Fax:
Practice Address - Street 1:1515 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4101
Practice Address - Country:US
Practice Address - Phone:920-253-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI001140133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist