Provider Demographics
NPI:1255691069
Name:ARCHER, DESHAUNTA LYNNA (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:DESHAUNTA
Middle Name:LYNNA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 SHERBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3744
Mailing Address - Country:US
Mailing Address - Phone:419-508-8321
Mailing Address - Fax:
Practice Address - Street 1:2705 SHERBROOKE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3744
Practice Address - Country:US
Practice Address - Phone:419-508-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 339774163W00000X
OH020503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse