Provider Demographics
NPI:1124223904
Name:ARCHAMBAULT, JANICE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:ARCHAMBAULT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 ARCHSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1875
Mailing Address - Country:US
Mailing Address - Phone:978-640-0294
Mailing Address - Fax:
Practice Address - Street 1:6306 ARCHSTONE AVE
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1875
Practice Address - Country:US
Practice Address - Phone:978-640-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse