Provider Demographics
NPI:1376982850
Name:CHAMPLIN, LENA CLARICE (NP-C)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:CLARICE
Last Name:CHAMPLIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24449
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0589
Mailing Address - Country:US
Mailing Address - Phone:833-351-8255
Mailing Address - Fax:
Practice Address - Street 1:109 W 27TH ST RM 5S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6208
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61613403363LP0808X
FLAPRN9288496363LP0808X
WAAP61611392363LP0808X
CA95017682363LP0808X
TN37418363LP0808X
TX1187226363LP0808X
NY403340363LP0808X
FLARNP9288496363LF0000X
MECNP171023363LP0808X
AZ301115363LP0808X
GARN255639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHO650WMedicare PIN
FLHO650VMedicare PIN
FLHO650YMedicare PIN