Healthcare Provider Details

I. General information

NPI: 1841476363
Provider Name (Legal Business Name): GENEVA CHASTANET-SEVERIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENEVA CHASTANET PMHNP

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 CHASE RD STE 210
DEARBORN MI
48126-0900
US

IV. Provider business mailing address

1425 STARR AVE
TOLEDO OH
43605-2456
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax: 832-241-2902
Mailing address:
  • Phone: 419-693-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 298606
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.022197
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704302911
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: