Provider Demographics
NPI:1073923074
Name:CHAMPAGNE, CHRISTINA JACOBSON (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:JACOBSON
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-901-5200
Mailing Address - Fax:760-635-1887
Practice Address - Street 1:320 SANTA FE DR STE 320
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-901-5200
Practice Address - Fax:760-635-1887
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235642176B00000X
CANP95000656363LW0102X
CANMW235642367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235642Other235642