Provider Demographics
NPI:1477663649
Name:EMBANKS, ROYCE WILLIAM JR (RN)
Entity Type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:WILLIAM
Last Name:EMBANKS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 SE TURNER ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1562
Mailing Address - Country:US
Mailing Address - Phone:541-475-5557
Mailing Address - Fax:
Practice Address - Street 1:733 SE TURNER ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1562
Practice Address - Country:US
Practice Address - Phone:541-475-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09000500RN163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care