Provider Demographics
NPI:1033445697
Name:NAVRA, JENNIFER DOMVILLE (CNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DOMVILLE
Last Name:NAVRA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 THE CIRCLE AT NORTH HILLS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5712
Mailing Address - Country:US
Mailing Address - Phone:919-781-9848
Mailing Address - Fax:919-714-8360
Practice Address - Street 1:4191 THE CIRCLE AT NORTH HILLS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5712
Practice Address - Country:US
Practice Address - Phone:919-781-9848
Practice Address - Fax:919-714-8360
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 10956-NP363LF0000X
NC5005824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016257Medicaid