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General NPI Number Information
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NPI Number | 1942849484
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Entity Type | Individual
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Provider Name | JAY MITCHELL JEVNE PMHNP
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Gender | Male
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1110 7TH AVE
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City | CUMBERLAND
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State | WI
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Zip | 54829-9138
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Country | US
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Telephone | 715-822-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 6TH AVE
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City | CUMBERLAND
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State | WI
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Zip | 54829-9103
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Country | US
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Telephone | 715-822-7200
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9972
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License Number State | WI
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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 | 9972
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License Number State | WI
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