MEDICARE: CHAMPION NURSING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse

General Provider Information

NPI Number	:	1265154363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION NURSING LLC

Provider Business Mailing Address
First Line	:	13807 MUIRFIELD VILLAGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1753
Country	:	US
Telephone Number	:	346-429-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	13807 MUIRFIELD VILLAGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1753
Country	:	US
Telephone Number	:	346-429-2422
Fax Number	:

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	ANGELA MARIE MERCHANT
Credential	:	RN
Telephone Number	:	346-429-2422

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/15/2022

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