Healthcare Provider Details

I. General information

NPI: 1962168401
Provider Name (Legal Business Name): VIRGINIE CHAVANNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MANSFIELD VLG
HACKETTSTOWN NJ
07840-3615
US

IV. Provider business mailing address

76 MANSFIELD VLG
HACKETTSTOWN NJ
07840-3615
US

V. Phone/Fax

Practice location:
  • Phone: 561-229-6153
  • Fax:
Mailing address:
  • Phone: 561-229-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01205400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: