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General NPI Number Information
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NPI Number | 1376098731
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Entity Type | Individual
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Provider Name | CHANTAL MAXENE LAJEUNESSE APRN
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Gender | Female
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 101 MARIETTA ST NW
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City | ATLANTA
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State | GA
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Zip | 30303-2720
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Country | US
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Telephone | 404-947-5800
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Fax | 404-947-5859
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Provider Business Mailing Address
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Address Line | 101 MARIETTA ST NW
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City | ATLANTA
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State | GA
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Zip | 30303-2720
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Country | US
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Telephone | 404-947-5800
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Fax | 404-947-5859
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN217424
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN217424
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN217424
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License Number State | GA
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