Basic Information
Provider Information | |||||||||
NPI: | 1487934014 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAMPNEY | ||||||||
FirstName: | BEATRICE | ||||||||
MiddleName: | MADELEINE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3304 SHASTA DAM BLVD | ||||||||
Address2: | SP. 58 | ||||||||
City: | SHASTA LAKE | ||||||||
State: | CA | ||||||||
PostalCode: | 960199583 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5302271962 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1716 COURT ST | ||||||||
Address2: | SUITE B | ||||||||
City: | REDDING | ||||||||
State: | CA | ||||||||
PostalCode: | 960011762 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5302232332 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/26/2011 | ||||||||
LastUpdateDate: | 08/26/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 417782 | CA | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.