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NPI Code Detail

MEDICARE: KATHY CHAMPAGNE

MEDICARE: KATHY CHAMPAGNE
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1073999728
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY CHAMPAGNE
Provider Business Mailing Address
First Line : 1375 R DALE WERTZ DR
Second Line :
City : BAD AXE
State : MI
Zip : 48413-1365
Country : US
Telephone Number : 989-269-9293
Fax Number : 989-269-7544
Provider Business Practice Location Address
First Line : 1375 R DALE WERTZ DR
Second Line :
City : BAD AXE
State : MI
Zip : 48413-1365
Country : US
Telephone Number : 989-269-9293
Fax Number : 989-269-7544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2015
Last Update Date : 12/14/2025

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Directions to “ KATHY CHAMPAGNE ” Practice Location

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