Provider Demographics
NPI:1003813007
Name:DAVE, ARCHANA A (MS, MBA)
Entity Type:Individual
Prefix:MISS
First Name:ARCHANA
Middle Name:A
Last Name:DAVE
Suffix:
Gender:F
Credentials:MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 WHITTINGTON CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4023
Mailing Address - Country:US
Mailing Address - Phone:847-414-7684
Mailing Address - Fax:
Practice Address - Street 1:1091 WHITTINGTON CT
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4023
Practice Address - Country:US
Practice Address - Phone:847-414-7684
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD10000162915172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver