Provider Demographics
NPI:1366400699
Name:CHAMPLIN, PATRICIA J (ANP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:CHAMPLIN CZUMAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CARTER STREET
Mailing Address - Street 2:ATTN KELLY STEELE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:120 GARDENVILLE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-668-3600
Practice Address - Fax:716-606-4003
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300246363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10767064OtherCAQH
NY9513172OtherIHA
NYP00189067OtherMEDICARE RAILROAD
NY000560338004OtherBCBS
NY159955BJOtherPREFERRED CARE
NY040511000506OtherFIDELIS
NY040511000506OtherFIDELIS
S66570Medicare UPIN