Healthcare Provider Details

I. General information

NPI: 1255691069
Provider Name (Legal Business Name): DESHAUNTA LYNNA ARCHER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 SHERBROOKE RD
TOLEDO OH
43606-3744
US

IV. Provider business mailing address

2705 SHERBROOKE RD
TOLEDO OH
43606-3744
US

V. Phone/Fax

Practice location:
  • Phone: 419-508-8321
  • Fax:
Mailing address:
  • Phone: 419-508-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number020503
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN. 339774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: