Provider Demographics
NPI:1790022945
Name:CHAMP, JOHNIE R (RN CRNP)
Entity Type:Individual
Prefix:MS
First Name:JOHNIE
Middle Name:R
Last Name:CHAMP
Suffix:
Gender:F
Credentials:RN CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5200 CENTRE AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1300
Mailing Address - Country:US
Mailing Address - Phone:412-621-7777
Mailing Address - Fax:412-683-8698
Practice Address - Street 1:5200 CENTRE AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1300
Practice Address - Country:US
Practice Address - Phone:412-621-7777
Practice Address - Fax:412-683-8698
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP012474364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health