Provider Demographics
NPI:1538877451
Name:CAMPISTA, TAYLOR (RD, LD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CAMPISTA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 SE MARINER WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-2953
Mailing Address - Country:US
Mailing Address - Phone:971-226-4265
Mailing Address - Fax:
Practice Address - Street 1:6221 SE MARINER WAY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-2953
Practice Address - Country:US
Practice Address - Phone:971-226-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10227473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered