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General NPI Number Information
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NPI Number | 1912042755
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Entity Type | Individual
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Provider Name | COLLEEN CHAMPLIN NP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 444 HOSPITAL WAY
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City | POCATELLO
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State | ID
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Zip | 83201-2701
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Country | US
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Telephone | 208-478-5600
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Fax | 208-478-8500
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Provider Business Mailing Address
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Address Line | 607 UNIVERSITY DR
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City | POCATELLO
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State | ID
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Zip | 83201-3433
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Country | US
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Telephone | 208-251-2328
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Fax | 208-478-8500
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP516A
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License Number State | ID
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