Provider Demographics
NPI:1730487851
Name:CHAMPA, WHITNEY L (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:L
Last Name:CHAMPA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2590
Mailing Address - Country:US
Mailing Address - Phone:701-456-6000
Mailing Address - Fax:701-456-6101
Practice Address - Street 1:2615 FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2590
Practice Address - Country:US
Practice Address - Phone:701-456-6000
Practice Address - Fax:701-456-6101
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant