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General NPI Number Information
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NPI Number | 1174313837
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Entity Type | Individual
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Provider Name | MR. JACQUELINE CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 409 E LABURNUM AVE STE 7
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City | RICHMOND
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State | VA
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Zip | 23222-2105
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Country | US
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Telephone | 804-839-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 409 E LABURNUM AVE STE 7
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City | RICHMOND
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State | VA
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Zip | 23222-2105
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Country | US
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Telephone |
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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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number | HCO-0005101
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License Number State | VA
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