Healthcare Provider Details

I. General information

NPI: 1033629068
Provider Name (Legal Business Name): CAILLE S ROY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date: 12/07/2017
Reactivation Date: 01/04/2018

III. Provider practice location address

57 RIVER RD
ANDOVER MA
01810-1144
US

IV. Provider business mailing address

34 HAVERHILL ST
LAWRENCE MA
01841-2884
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-0090
  • Fax:
Mailing address:
  • Phone: 978-686-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2304011
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number072693-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: