Provider Demographics
NPI:1962727941
Name:ARCHIBALD, FREDERICA (LPN)
Entity type:Individual
Prefix:MS
First Name:FREDERICA
Middle Name:
Last Name:ARCHIBALD
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 1:556 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-6212
Mailing Address - Country:US
Mailing Address - Phone:718-498-0648
Mailing Address - Fax:
Practice Address - Street 1:45-66 162 STREET SUITE 1
Practice Address - Street 2:DELS COMPREHENSIVE HEALTH CARE REGISTRY AGENCY INC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3158
Practice Address - Country:US
Practice Address - Phone:718-539-8044
Practice Address - Fax:718-539-8045
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1609042175Medicaid