Provider Demographics
NPI:1174674717
Name:ARCHER, LINDA L (RN, CNS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:ARCHER
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNS
Mailing Address - Street 1:4535 FORSYTHE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3218
Mailing Address - Country:US
Mailing Address - Phone:719-390-3716
Mailing Address - Fax:
Practice Address - Street 1:4300 CHERRY CREEK DR S
Practice Address - Street 2:PSD-WHS-A4
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1530
Practice Address - Country:US
Practice Address - Phone:303-692-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO125267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65353552Medicaid