Provider Demographics
NPI:1881234193
Name:ARCH, DEIDRE LYNN (CNP)
Entity type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:LYNN
Last Name:ARCH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CHANCELLOR CIR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2539
Mailing Address - Country:US
Mailing Address - Phone:440-653-5175
Mailing Address - Fax:
Practice Address - Street 1:6801 BRECKSVILLE RD STE 10
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5057
Practice Address - Country:US
Practice Address - Phone:216-444-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025302363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health