Provider Demographics
NPI:1154645802
Name:ARCHBOLD, REINA MARIA (LPN)
Entity type:Individual
Prefix:MS
First Name:REINA
Middle Name:MARIA
Last Name:ARCHBOLD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 196TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2550
Mailing Address - Country:US
Mailing Address - Phone:917-561-4812
Mailing Address - Fax:
Practice Address - Street 1:11211 196TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2550
Practice Address - Country:US
Practice Address - Phone:917-561-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296088-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse