Healthcare Provider Details

I. General information

NPI: 1679031314
Provider Name (Legal Business Name): CHASITY ARCHER CNRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVE STE 105
TOLEDO OH
43606-3819
US

IV. Provider business mailing address

2130 W CENTRAL AVE STE 105
TOLEDO OH
43606-3819
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4590
  • Fax:
Mailing address:
  • Phone: 419-291-4590
  • Fax: 419-291-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030050
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0030050
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0030050
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN388578
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: