Provider Demographics
NPI:1821351727
Name:CHAMPLIN, ROSANNE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:MARIE
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9682
Mailing Address - Country:US
Mailing Address - Phone:740-927-9460
Mailing Address - Fax:740-927-9460
Practice Address - Street 1:5100 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1607
Practice Address - Country:US
Practice Address - Phone:614-644-1810
Practice Address - Fax:614-544-1814
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-216768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily