Basic Information
| Provider Information | |||||||||
| NPI: | 1679031314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCHER | ||||||||
| FirstName: | CHASITY | ||||||||
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| Credential: | CNRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2130 W CENTRAL AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192914590 | ||||||||
| FaxNumber: | 4192916747 | ||||||||
| Practice Location | |||||||||
| Address1: | 2130 W CENTRAL AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192914590 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2019 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0800X | RN388578 | OH | N | Nursing Service Providers | Registered Nurse | Neuroscience | 363L00000X | APRN.CNP.0030050 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.