Provider Demographics
NPI:1427124106
Name:CHAMPLIN, MARTHA J (CRNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2500
Mailing Address - Country:US
Mailing Address - Phone:610-269-9448
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:217 REECEVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1572
Practice Address - Country:US
Practice Address - Phone:610-269-9448
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN25927L163W00000X
PAVP003203C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021680Medicare ID - Type Unspecified
PAS67783Medicare UPIN