Provider Demographics
NPI:1780955393
Name:CHAMPION, JANE LAND (MSN-ANP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LAND
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MSN-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:
Practice Address - Street 1:8000 FRANKFORD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6894
Practice Address - Country:US
Practice Address - Phone:972-232-8080
Practice Address - Fax:800-281-9558
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716846363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295017201Medicaid
TX295017201Medicaid
TXP01120598Medicare PIN