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General NPI Number Information
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NPI Number | 1063860443
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Entity Type | Individual
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Provider Name | MARY MELISSA CAMPBELL L.AC., LMT
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 769 ATLANTIC CITY BLVD STE 6
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City | BAYVILLE
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State | NJ
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Zip | 08721-2540
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Country | US
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Telephone | 732-664-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 769 ATLANTIC CITY BLVD STE 6
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City | BAYVILLE
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State | NJ
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Zip | 08721-2540
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Country | US
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Telephone | 732-664-9220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 117900
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License Number State | NJ
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