Provider Demographics
NPI:1376098731
Name:LAJEUNESSE, CHANTAL MAXENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:MAXENE
Last Name:LAJEUNESSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARIETTA ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2720
Mailing Address - Country:US
Mailing Address - Phone:404-947-5800
Mailing Address - Fax:404-947-5859
Practice Address - Street 1:101 MARIETTA ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2720
Practice Address - Country:US
Practice Address - Phone:404-947-5800
Practice Address - Fax:404-947-5859
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217424163W00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health