Basic Information
| Provider Information | |||||||||
| NPI: | 1831365659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROYE | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 WHIPPLE ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029083258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015190330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | CLAVERICK 2 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015191604 | ||||||||
| FaxNumber: | 4012720538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | NPP37464 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363L00000X | NP37464 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0070604631 | 01 | RI | RI MEDICARE | OTHER | 07-14-2011 | 01 | RI | UNITED HEALTHCARE | OTHER | 939025129 | 01 | RI | GROUP RI MEDICARE | OTHER | 06012011 | 01 | RI | BCBSRI | OTHER | 110088781A | 05 | MA | MEDICAID | PR70404 | 05 | RI | MEDICAID |