Healthcare Provider Details

I. General information

NPI: 1376064915
Provider Name (Legal Business Name): ERNESTINA S ARCHER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 FEDERAL ST
CAMDEN NJ
08103-1539
US

IV. Provider business mailing address

890 BENNETTS MILLS RD
JACKSON NJ
08527-2736
US

V. Phone/Fax

Practice location:
  • Phone: 856-583-2496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00739700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: