Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | S1782 | TX |
NPI | 1003180993 |
---|---|
Provider Name | Dr. Amanda Hope Champlain |
First Address | Frisco, TX 75033-0289 |
Second Address | Frisco, TX 75033-0289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2012 |
Last Update Date | 20/10/2021 |