Basic Information
| Provider Information | |||||||||
| NPI: | 1578785101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.P.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 473 ALFRED ROAD | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072839031 | ||||||||
| FaxNumber: | 2072849825 | ||||||||
| Practice Location | |||||||||
| Address1: | 473 ALFRED ROAD | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072839031 | ||||||||
| FaxNumber: | 2072849825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | R024810 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.