Healthcare Provider Details

I. General information

NPI: 1245794478
Provider Name (Legal Business Name): CHAMPAGNE DAVID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST FL 2
COLUMBUS OH
43222-1464
US

IV. Provider business mailing address

3985 SILVER SPRINGS LN
COLUMBUS OH
43230-9875
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-0822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042864
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: