# ILA CHAMPINE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538282504
- **Gender:** F
- **Credential:** PA-C, RD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | 192 | AK | — |
| 133V00000X | Registered Dietitian | DI 60680930 | WA | — |
| 363A00000X | Physician Assistant | PA60688882 | WA | Yes |

## Other

- **Enumeration date:** 04/06/2007
- **Last updated:** 07/29/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2088901 | — | WA |