Individual
JENNIFER R ARCHIBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1069 W BROAD ST, SUITE 908, FALLS CHURCH, VA 22046-4610
(877) 230-9617
Mailing address
1069 W BROAD ST, FALLS CHURCH, VA 22046-4610
(877) 230-9617
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110004222
VA
363AS0400X
Surgical Physician Assistant
655
MT
363AS0400X
Surgical Physician Assistant
C03660
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1081067
NCCPA
—
01
—
1144409103
BCBS
MT
05
—
1144409103
—
MT
Enumeration date
10/26/2007
Last updated
05/17/2013
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