Provider Demographics
NPI:1609211192
Name:ARCHBOLD, CHRISSY
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:
Last Name:ARCHBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3171
Mailing Address - Country:US
Mailing Address - Phone:507-537-6713
Mailing Address - Fax:507-537-6719
Practice Address - Street 1:607 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3171
Practice Address - Country:US
Practice Address - Phone:507-537-6713
Practice Address - Fax:507-537-6719
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 124520-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse