Provider Demographics
NPI:1679031314
Name:ARCHER, CHASITY (CNRN)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 W CENTRAL AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3819
Mailing Address - Country:US
Mailing Address - Phone:419-291-4590
Mailing Address - Fax:419-291-6747
Practice Address - Street 1:2130 W CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3819
Practice Address - Country:US
Practice Address - Phone:419-291-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN388578163WN0800X
OHAPRN.CNP.0030050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience