| Champion Wellness, Inc. | |
|
9723 109th Street Ct Sw Lakewood WA 98498-3059 | |
| (253) 342-4713 | |
| Not Available |
| Full Name | Champion Wellness, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 9723 109th Street Ct Sw, Lakewood, Washington |
| Authorized Official Name and Position | Shnarika Simone Powell (PMHNP) |
| Authorized Official Contact | 7064894719 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Champion Wellness, Inc. 9723 109th Street Ct Sw Lakewood WA 98498-3059 Ph: (253) 342-4713 | Champion Wellness, Inc. 9723 109th Street Ct Sw Lakewood WA 98498-3059 Ph: (253) 342-4713 |
| NPI Number | 1679266126 |
|---|---|
| Provider Enumeration Date | 05/31/2023 |
| Last Update Date | 01/17/2026 |
| Certification Date | 01/17/2026 |
| Medicare PECOS PAC ID | 0042740896 |
|---|---|
| Medicare Enrollment ID | O20250207002425 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679266126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Shnarika Simone Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720786858 PECOS PAC ID: 8921538778 Enrollment ID: I20250207002751 |
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