Provider Demographics
NPI:1356118632
Name:CHAMPLIN, REBECCA (APRN)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SALEM TPKE STE 8
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7403
Mailing Address - Country:US
Mailing Address - Phone:860-889-9180
Mailing Address - Fax:860-886-0024
Practice Address - Street 1:111 SALEM TPKE STE 8
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7403
Practice Address - Country:US
Practice Address - Phone:860-889-9180
Practice Address - Fax:860-886-0024
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily