Healthcare Provider Details

I. General information

NPI: 1033541370
Provider Name (Legal Business Name): JACQUELINE J CAMPBELL MS, RD, CDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HAZARD AVE
ENFIELD CT
06082-4613
US

IV. Provider business mailing address

39 CONCORD TER
SOMERS CT
06071-1907
US

V. Phone/Fax

Practice location:
  • Phone: 860-698-0656
  • Fax: 860-929-0858
Mailing address:
  • Phone: 413-854-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: