Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | L-092677 | IA |
NPI | 1023145208 |
---|---|
Provider Name | Mrs. Andrea R Archer |
First Address | Davenport, IA 52803-2459 |
Second Address | Davenport, IA 52803-2459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0442392 | (05) | IA |
Q18531 | (02) |