Healthcare Provider Details

I. General information

NPI: 1861643694
Provider Name (Legal Business Name): JENNIFER CAMPBELL RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST FL 4
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3346
  • Fax: 916-733-3320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number867402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: