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NPI Code Detail

MEDICARE: MRS. LYZZA ARCHIPOV

MEDICARE: MRS. LYZZA ARCHIPOV
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1245419423
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYZZA ARCHIPOV
Provider Business Mailing Address
First Line : 3487 BROADWAY AVENUE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-7213
Country : US
Telephone Number : 239-334-9555
Fax Number : 239-334-2439
Provider Business Practice Location Address
First Line : 3487 BROADWAY AVENUE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-7213
Country : US
Telephone Number : 239-334-9555
Fax Number : 239-334-2439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2007
Last Update Date : 05/16/2016

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Directions to “ MRS. LYZZA ARCHIPOV ” Practice Location

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