Provider Demographics
NPI:1629346655
Name:ARCHER, JOAN PATRICIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:PATRICIA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5220
Mailing Address - Country:US
Mailing Address - Phone:607-757-2811
Mailing Address - Fax:
Practice Address - Street 1:1200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5220
Practice Address - Country:US
Practice Address - Phone:607-757-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220972-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool