Individual
ANGELICA MARIE CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11315 212TH ST, QUEENS VILLAGE, NY 11429-2311
(718) 801-9257
Mailing address
11315 212TH ST, QUEENS VILLAGE, NY 11429-2311
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
343646
NY
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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