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General NPI Number Information
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NPI Number | 1245506815
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Entity Type | Individual
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Provider Name | JACQUELYN DORN CAMPBELL M.S.,L.D.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 522 E PIERCE ST
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City | LULING
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State | TX
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Zip | 78648-2613
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Country | US
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Telephone | 830-351-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 409 E JONES ST
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City | LULING
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State | TX
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Zip | 78648-1943
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Country | US
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Telephone | 830-875-5507
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | DT01962
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License Number State | TX
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