Provider Demographics
NPI:1285950600
Name:CHAMPE, MIRLINE
Entity type:Individual
Prefix:MS
First Name:MIRLINE
Middle Name:
Last Name:CHAMPE
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 1:5 MANOR DR
Mailing Address - Street 2:APT 15H
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3276
Mailing Address - Country:US
Mailing Address - Phone:862-234-6472
Mailing Address - Fax:
Practice Address - Street 1:5 MANOR DR
Practice Address - Street 2:APT 15H
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3276
Practice Address - Country:US
Practice Address - Phone:862-234-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse