Provider Demographics
NPI:1891046520
Name:ARCHER, AMY ELIZABETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:ARCHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6919
Mailing Address - Country:US
Mailing Address - Phone:408-206-2376
Mailing Address - Fax:408-741-1559
Practice Address - Street 1:500 DIVISION ST
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6919
Practice Address - Country:US
Practice Address - Phone:408-206-2376
Practice Address - Fax:408-741-1559
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered