Provider Demographics
NPI:1407623960
Name:EHIRIM, JAYNE CHINWOKE (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:CHINWOKE
Last Name:EHIRIM
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 COLLIER DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2353
Mailing Address - Country:US
Mailing Address - Phone:925-364-1368
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1471
Practice Address - Country:US
Practice Address - Phone:847-759-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036025363LP0808X
IL209028770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health