Provider Demographics
NPI:1689212193
Name:CHAUVIN, JENNIFER (PMHNP-BC, DNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHAUVIN
Suffix:
Gender:F
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 JUAREZ ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1032
Mailing Address - Country:US
Mailing Address - Phone:310-913-8080
Mailing Address - Fax:
Practice Address - Street 1:20 JUAREZ STREET
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:310-913-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201910489NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health