Healthcare Provider Details

I. General information

NPI: 1780500413
Provider Name (Legal Business Name): DARA S CHAMPION RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 WISHBONE DR
BELMONT NC
28012-4311
US

IV. Provider business mailing address

2345 WISHBONE DR
BELMONT NC
28012-4311
US

V. Phone/Fax

Practice location:
  • Phone: 704-240-0441
  • Fax:
Mailing address:
  • Phone: 704-240-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number094814
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: