Provider Demographics
NPI:1922155001
Name:CHAMPION, CANAAN MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:CANAAN
Middle Name:MARIE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CANAAN
Other - Middle Name:MARIE
Other - Last Name:WINFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2719 HIGHWAY 351
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-6931
Mailing Address - Country:US
Mailing Address - Phone:870-403-1225
Mailing Address - Fax:870-203-0712
Practice Address - Street 1:1523 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858-9223
Practice Address - Country:US
Practice Address - Phone:870-403-1225
Practice Address - Fax:870-203-0712
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 92363367500000X
GARN164615367500000X
ARC02654 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered