Provider Demographics
NPI:1073942413
Name:CAMPBELL, JENNELL LEANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JENNELL
Middle Name:LEANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8040
Mailing Address - Country:US
Mailing Address - Phone:308-379-0873
Mailing Address - Fax:
Practice Address - Street 1:409 E DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-8040
Practice Address - Country:US
Practice Address - Phone:308-379-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2257124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist