Provider Demographics
NPI:1467030114
Name:ROYCE, REBECCA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:ROYCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5234 VIRGINIA LN SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9234
Mailing Address - Country:US
Mailing Address - Phone:269-760-4787
Mailing Address - Fax:
Practice Address - Street 1:695 KENMOOR AVE SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2375
Practice Address - Country:US
Practice Address - Phone:616-956-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704262250363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology