Provider Demographics
NPI:1306031679
Name:CHAMPINE, MARJORIE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANN
Last Name:CHAMPINE
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:PO BOX 20232
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-0232
Mailing Address - Country:US
Mailing Address - Phone:937-768-3054
Mailing Address - Fax:
Practice Address - Street 1:275 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2311
Practice Address - Country:US
Practice Address - Phone:937-768-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 127127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse