Provider Demographics
NPI:1316287253
Name:CAMP, JACQUELINE H (RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:H
Last Name:CAMP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2855
Mailing Address - Country:US
Mailing Address - Phone:843-774-1222
Mailing Address - Fax:843-841-3881
Practice Address - Street 1:405 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2855
Practice Address - Country:US
Practice Address - Phone:843-774-1222
Practice Address - Fax:843-841-3881
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56959163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool