Healthcare Provider Details

I. General information

NPI: 1013369255
Provider Name (Legal Business Name): MEGAN MAUREEN CHAMPION N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MAUREEN SMITH

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 E BRIARWOOD AVE SUITE 105
CENTENNIAL CO
80112-3930
US

IV. Provider business mailing address

13111 E BRIARWOOD AVE SUITE 105
CENTENNIAL CO
80112-3930
US

V. Phone/Fax

Practice location:
  • Phone: 303-632-3640
  • Fax: 303-632-3642
Mailing address:
  • Phone: 303-632-3640
  • Fax: 303-632-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0182920
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992382
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: