Provider Demographics
NPI:1366885659
Name:CHAMPION, DENA (MS, RD, LD, CNSC)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST 180 DOAN, 410 WEST 10TH AVENUE
Mailing Address - Street 2:THE OSU WEXNER MEDICAL CENTER, NUTRITION SERVICES
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-8654
Mailing Address - Fax:
Practice Address - Street 1:WEST 180 DOAN, 410 WEST 10TH AVENUE
Practice Address - Street 2:THE OSU WEXNER MEDICAL CENTER, NUTRITION SERVICES
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6565133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic