Provider Demographics
NPI:1639902901
Name:ARCHER, CHRISTINA DIANE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SKYLINE LN
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1349
Mailing Address - Country:US
Mailing Address - Phone:813-501-2201
Mailing Address - Fax:
Practice Address - Street 1:450 SKYLINE LN
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1349
Practice Address - Country:US
Practice Address - Phone:813-501-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide