Individual
NICOLE M ROYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
19450 DEERFIELD AVENUE, SUITE 325, LEESBURG, VA 20176-8503
(571) 252-8119
(800) 735-1643
Mailing address
224-D CORNWALL ST., NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-007675
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720610132
—
VA
05
—
30017582100001
—
VA
Enumeration date
02/04/2020
Last updated
11/20/2023
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