Elizabeth Marie Archer
Individual provider Active NPI Contractor · Saint Cloud, MN
NPI 1124368238 · NPPES record last updated Feb 26, 2013
Key facts
- NPI
- 1124368238
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 800112-1-RH (MN)
- Practice address
- 307 20TH Ave N
Saint Cloud, MN 56303-3830 - Phone
- (320) 253-5981
- Fax
- (320) 259-1432
- NPI assigned
- Feb 26, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 800112-1-RH | MN | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 800112-1-RH | MN | Yes |
Addresses
Primary practice location
307 20TH Ave N
Saint Cloud, MN 56303-3830
Mailing address
307 20TH Ave N
Saint Cloud, MN 56303-3830
Phone (320) 253-5981
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A350025000 | Other | MN | UMPI |
Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.