Provider Demographics
NPI:1790045565
Name:ARCHER, ROSE R (RN BA)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:R
Last Name:ARCHER
Suffix:
Gender:F
Credentials:RN BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-0385
Mailing Address - Country:US
Mailing Address - Phone:828-632-4970
Mailing Address - Fax:828-632-4969
Practice Address - Street 1:577 NC HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-9986
Practice Address - Country:US
Practice Address - Phone:828-632-4970
Practice Address - Fax:828-632-4969
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse