Basic Information
| Provider Information | |||||||||
| NPI: | 1780955393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMPION | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | LAND | ||||||||
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| Credential: | MSN-ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104022379 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8000 FRANKFORD RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752526894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722328080 | ||||||||
| FaxNumber: | 8002819558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 716846 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 295017201 | 05 | TX | MEDICAID |