Individual
ILA CHAMPINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, RD
Contact information
Practice address
2525 NE 139TH ST STE 130, VANCOUVER, WA 98686-2719
(360) 882-2778
(360) 604-1675
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
(360) 604-1771
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
192
AK
133V00000X
Registered Dietitian
DI 60680930
WA
363A00000X
Physician Assistant
Primary
PA60688882
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2088901
—
WA
Enumeration date
04/06/2007
Last updated
07/29/2019
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