Provider Demographics
NPI:1508280496
Name:CHAMPION, STEPHEN WAYNE (RN)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WAYNE
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25830 N 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1014
Mailing Address - Country:US
Mailing Address - Phone:602-312-1495
Mailing Address - Fax:
Practice Address - Street 1:25830 N 64TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1014
Practice Address - Country:US
Practice Address - Phone:602-312-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ168614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse