Provider Demographics
NPI:1013234087
Name:CHAMPAIGN, SUZANNE E (RN)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:E
Last Name:CHAMPAIGN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 E FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7461
Mailing Address - Country:US
Mailing Address - Phone:602-381-6018
Mailing Address - Fax:602-381-6020
Practice Address - Street 1:1100 N 35TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5210
Practice Address - Country:US
Practice Address - Phone:602-381-4665
Practice Address - Fax:602-381-4662
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse