Provider Demographics
NPI:1962168401
Name:CHAVANNES, VIRGINIE
Entity type:Individual
Prefix:
First Name:VIRGINIE
Middle Name:
Last Name:CHAVANNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MANSFIELD VLG
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3615
Mailing Address - Country:US
Mailing Address - Phone:561-229-6153
Mailing Address - Fax:
Practice Address - Street 1:76 MANSFIELD VLG
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3615
Practice Address - Country:US
Practice Address - Phone:561-229-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01205400363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology