Provider Demographics
NPI:1669024048
Name:ARCHIE, ERRYNNE REBEKKAH
Entity type:Individual
Prefix:
First Name:ERRYNNE
Middle Name:REBEKKAH
Last Name:ARCHIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ERRYNE
Other - Middle Name:REBEKKA LEPLAT
Other - Last Name:ARCHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1506 BROOK PARK WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7340
Mailing Address - Country:US
Mailing Address - Phone:916-759-2815
Mailing Address - Fax:
Practice Address - Street 1:1620 SANTA CLARA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3558
Practice Address - Country:US
Practice Address - Phone:916-862-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor