Individual provider · NPI-1

Reine Mary Archer, FNP

Nurse Practitioner, Family · Stony Brook, NY

NPI number1376107748
StatusActive
Last updated in NPPESSep 27, 2023

Details

NPI
1376107748
Entity type
Individual (NPI-1)
Name
Reine Mary Archer
Credential
FNP
Sex
Female
Sole proprietor
No
Enumeration date
Apr 30, 2019
Certification date
Sep 27, 2023
Last updated
Sep 27, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, FamilyF342125-01NYYes

Practice location

101 Nicolls Rd
Stony Brook, NY 11794-0001

Phone 631-689-8333

Mailing address

615 Broadway Apt 82
Amityville, NY 11701-2143

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