Earlis Randall Champagne, RN
Individual provider Active NPI Registered Nurse · Gardnerville, NV
NPI 1194095190 · NPPES record last updated Jan 6, 2012
Key facts
- NPI
- 1194095190
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- TRN 332256 (NV)
- Practice address
- 1528 US Highway 395 N
Suite 100
Gardnerville, NV 89410-5265 - Phone
- (775) 782-3671
- Fax
- (775) 782-6639
- NPI assigned
- Jan 6, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TRN 332256 | NV | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | TRN 332256 | NV | Yes |
Addresses
Primary practice location
1528 US Highway 395 N
Suite 100
Gardnerville, NV 89410-5265
Mailing address
1665 Old Hot Springs Rd
Suite 157
Carson City, NV 89706-0782
Phone (775) 687-5162
Other providers in Gardnerville, NV
- Carson Valley Medical Center Rural Health Clinic
- Carson Valley Senior Living LLC
- Tracy Cassity
- Rachel Angeline Castaneda
- John J Cerny
- Rebecca Chauvin
- Rachel Jean Britta Cherry
- Christine C Salvo
- Karah R Clemons
- Carol Ann Coats
All providers in Gardnerville, NV · Registered Nurse in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.