Provider Demographics
NPI:1134650328
Name:ARCHER, RITA JAYNE (SI)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:JAYNE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:SI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-6658
Mailing Address - Country:US
Mailing Address - Phone:570-424-8486
Mailing Address - Fax:
Practice Address - Street 1:5203 HAMILTON S
Practice Address - Street 2:
Practice Address - City:SAYLORSBURG
Practice Address - State:PA
Practice Address - Zip Code:18353-8227
Practice Address - Country:US
Practice Address - Phone:917-903-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist