Provider Demographics
NPI:1245914647
Name:ROY, ELICIA (RN, BSN)
Entity type:Individual
Prefix:
First Name:ELICIA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EDEN HL
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9783
Mailing Address - Country:US
Mailing Address - Phone:413-977-9412
Mailing Address - Fax:
Practice Address - Street 1:2 EDEN HL
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9783
Practice Address - Country:US
Practice Address - Phone:413-977-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211050163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse