Healthcare Provider Details

I. General information

NPI: 1326276056
Provider Name (Legal Business Name): LAURA ANN ARCHER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANN STARK R.N.

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0963
US

IV. Provider business mailing address

9371 S COUNTY ROAD 100 E
CLAYTON IN
46118-9215
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7572
  • Fax:
Mailing address:
  • Phone: 317-539-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number28108666A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: