Provider Demographics
NPI:1518718477
Name:DIVURGENT SOLUTIONS, LLC
Entity type:Organization
Organization Name:DIVURGENT SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:931-494-0456
Mailing Address - Street 1:1161 NW OVERTON ST APT 1614
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2598
Mailing Address - Country:US
Mailing Address - Phone:931-494-0456
Mailing Address - Fax:
Practice Address - Street 1:4225 SW HUBER ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6140
Practice Address - Country:US
Practice Address - Phone:503-893-2307
Practice Address - Fax:971-484-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty