Provider Demographics
NPI:1215713177
Name:CHAMPION, TYEISHA
Entity type:Individual
Prefix:
First Name:TYEISHA
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 SUMMIT RD STE G20
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2800
Mailing Address - Country:US
Mailing Address - Phone:513-918-6531
Mailing Address - Fax:
Practice Address - Street 1:1821 SUMMIT RD STE G20
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2800
Practice Address - Country:US
Practice Address - Phone:513-918-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401598401213251J00000X
251G00000X, 282E00000X, 376K00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251G00000XAgenciesHospice Care, Community Based
No282E00000XHospitalsLong Term Care Hospital
No376K00000XNursing Service Related ProvidersNurse's Aide
No282NC2000XHospitalsGeneral Acute Care HospitalChildren