Provider Demographics
NPI:1598958282
Name:ARCHER, DANA (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:SUNGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3186
Mailing Address - Country:US
Mailing Address - Phone:630-323-6116
Mailing Address - Fax:630-323-6169
Practice Address - Street 1:951 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8427
Practice Address - Country:US
Practice Address - Phone:815-744-4551
Practice Address - Fax:815-744-4756
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400140570Medicare PIN