MEDICARE: AMANDA CHRISTINE ARCHER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.394368	OH

General Provider Information

NPI Number	:	1588081350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CHRISTINE ARCHER RN

Provider Business Mailing Address
First Line	:	308 10TH STREET NW
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-1517
Country	:	US
Telephone Number	:	330-407-2426
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 10TH STREET NW
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-1517
Country	:	US
Telephone Number	:	330-407-2426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	02/15/2019

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