Healthcare Provider Details

I. General information

NPI: 1871967505
Provider Name (Legal Business Name): DEBRA CHAMPEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

V. Phone/Fax

Practice location:
  • Phone: 920-296-6065
  • Fax:
Mailing address:
  • Phone: 608-284-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberM087406
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: