Champine, Ila

Champine, Ila is an individual health care provider with primary practice located at 2525 Ne 139Th St Ste 130 , Vancouver WA 98686-2719. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Dietary & Nutritional Service Providers / Dietitian, Registered. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Champine, Ila can be contacted via phone (360) 882-2778.

Contact Information

Primary practice address
2525 Ne 139Th St Ste 130 Vancouver WA 98686-2719
Phone: (360) 882-2778
Fax: (360) 604-1675
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA60688882 Washington
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 192 Alaska
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X DI 60680930 Washington

Profile Details

NPI number 1538282504
LBN Legal business name Champine, Ila
Credentials PA-C, RD
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 6th, 2007
Last updated Jul 29th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538282504 NPPES
Washington MEDICAID 2088901

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