MEDICARE: CAROL CHAMPION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	620481-1	NY

General Provider Information

NPI Number	:	1013330240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL CHAMPION

Provider Business Mailing Address
First Line	:	1656 E 2ND ST
Second Line	:	APT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1656 E 2ND ST
Second Line	:	APT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6920
Country	:	US
Telephone Number	:	917-450-5592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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Directions to “ CAROL CHAMPION ” Practice Location

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