Provider Demographics
NPI:1124271333
Name:CHAMPION, NITA JILL (ND)
Entity type:Individual
Prefix:DR
First Name:NITA
Middle Name:JILL
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:NITA
Other - Middle Name:JILL
Other - Last Name:KESKITALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:10505 WAYZATA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1502
Mailing Address - Country:US
Mailing Address - Phone:952-417-1912
Mailing Address - Fax:952-417-1913
Practice Address - Street 1:10505 WAYZATA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:952-417-1912
Practice Address - Fax:952-417-1913
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-990175F00000X
MN1019175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath