Provider Demographics
NPI:1194613430
Name:PULVER, ROY JR (RN)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:PULVER
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:CLAVERACK
Mailing Address - State:NY
Mailing Address - Zip Code:12513-0105
Mailing Address - Country:US
Mailing Address - Phone:518-858-7714
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 105
Practice Address - Street 2:
Practice Address - City:CLAVERACK
Practice Address - State:NY
Practice Address - Zip Code:12513-0105
Practice Address - Country:US
Practice Address - Phone:518-858-7714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY805903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse