Provider Demographics
NPI:1871302240
Name:ARCHER, CHRISTINE BLANC (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BLANC
Last Name:ARCHER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 DENNIS MAGRUDER DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2110
Mailing Address - Country:US
Mailing Address - Phone:240-988-2176
Mailing Address - Fax:
Practice Address - Street 1:509 DENNIS MAGRUDER DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2110
Practice Address - Country:US
Practice Address - Phone:240-988-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR155997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health