Provider Demographics
NPI:1487183836
Name:ARCHER, CAROLYN JOANNA (MSC, RDN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOANNA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MSC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 DERBY RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5804
Mailing Address - Country:US
Mailing Address - Phone:248-840-5853
Mailing Address - Fax:
Practice Address - Street 1:1155 DERBY RD
Practice Address - Street 2:APT 3
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-840-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered