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General NPI Number Information
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NPI Number | 1104407691
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Entity Type | Individual
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Provider Name | SAMARA A CHAMPION MSN, APRN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 01/02/2022
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Provider Practice Location Address
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Address Line | 1550 CLINTON ST
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City | MUSKEGON
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State | MI
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Zip | 49442-5007
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Country | US
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Telephone | 231-737-1335
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Fax |
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Provider Business Mailing Address
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Address Line | 7834 TAYLOR RIDGE DR
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City | DELTON
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State | MI
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Zip | 49046-7806
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Country | US
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Telephone | 616-890-0087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4704232661
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704232661NSA2109F
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License Number State | MI
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