Provider Demographics
NPI:1841476363
Name:CHASTANET-SEVERIN, GENEVA (APRN)
Entity type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:
Last Name:CHASTANET-SEVERIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GENEVA
Other - Middle Name:
Other - Last Name:CHASTANET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1425 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2456
Mailing Address - Country:US
Mailing Address - Phone:419-693-0631
Mailing Address - Fax:
Practice Address - Street 1:5901 CHASE RD STE 210
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-0900
Practice Address - Country:US
Practice Address - Phone:832-869-4818
Practice Address - Fax:832-241-2902
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 298606163W00000X
OHAPRN.CNP.022197363LP0808X
MI4704302911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse