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General NPI Number Information
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NPI Number | 1518718477
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Entity Type | Organization
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Legal Business Name | DIVURGENT SOLUTIONS, LLC
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 4225 SW HUBER ST STE 300
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City | PORTLAND
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State | OR
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Zip | 97219-6140
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Country | US
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Telephone | 503-893-2307
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Fax | 971-484-1979
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Provider Business Mailing Address
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Address Line | 1161 NW OVERTON ST APT 1614
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City | PORTLAND
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State | OR
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Zip | 97209-2598
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Country | US
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Telephone | 931-494-0456
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHNNI CANSLER
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 931-494-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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