Provider Demographics
NPI:1861257321
Name:CHAUVIN, MICHELLE (RN, PMHNP-STUDENT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHAUVIN
Suffix:
Gender:F
Credentials:RN, PMHNP-STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4612
Mailing Address - Country:US
Mailing Address - Phone:318-294-0084
Mailing Address - Fax:
Practice Address - Street 1:306 SAM SIBLEY DRIVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71497-0001
Practice Address - Country:US
Practice Address - Phone:318-294-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse