Provider Demographics
NPI:1811025752
Name:CAMPBELL, JEANETTE ELAINE (LAC,DIPOM)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ELAINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAC,DIPOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3708
Mailing Address - Country:US
Mailing Address - Phone:928-639-3700
Mailing Address - Fax:928-223-4270
Practice Address - Street 1:719 N 5TH ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3708
Practice Address - Country:US
Practice Address - Phone:928-639-3700
Practice Address - Fax:928-223-4270
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0515171100000X
AZ10056171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0515OtherSTATE ACUPUNCTURE LICENSE