MEDICARE: MARISSA IONE CAMPBELL RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1619820255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA IONE CAMPBELL RD

Provider Business Mailing Address
First Line	:	4412 LANDFALL DR
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2312
Country	:	US
Telephone Number	:	757-608-8524
Fax Number	:

Provider Business Practice Location Address
First Line	:	1674 FOLLY RD APT 1001
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-8725
Country	:	US
Telephone Number	:	757-608-8524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ MARISSA IONE CAMPBELL RD” Practice Location

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