Healthcare Provider Details

I. General information

NPI: 1013169457
Provider Name (Legal Business Name): MICHELLE ANN ARCHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE LN UNIT 105
DURANGO CO
81301-7490
US

IV. Provider business mailing address

451 GROVES DR
DURANGO CO
81301-6322
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-3020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA.0005549
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.003242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: