Provider Demographics
NPI:1295087492
Name:ARCHIBALD, SARAH LAURIE (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LAURIE
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LAURIE
Other - Last Name:BLEFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:111 COUNTY CIR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9255
Mailing Address - Country:US
Mailing Address - Phone:413-545-2337
Mailing Address - Fax:413-545-9602
Practice Address - Street 1:111 COUNTY CIR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9255
Practice Address - Country:US
Practice Address - Phone:413-545-2337
Practice Address - Fax:413-545-9602
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202677163W00000X, 363LP0808X
CO1637248163W00000X
CO0000441-NP363LP0808X
MARN2270550363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420968100Medicaid
MD420968100Medicaid