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NPI Code Detail

MEDICARE: TRUDI A BUCK AGNP-C

MEDICARE: TRUDI A BUCK AGNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse PractitionerAPRN04880RI

General Provider Information

NPI Number : 1720963168
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRUDI A BUCK AGNP-C
Provider Business Mailing Address
First Line : 725 RESERVOIR AVE STE 103
Second Line :
City : CRANSTON
State : RI
Zip : 02910-4451
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 725 RESERVOIR AVE STE 103
Second Line :
City : CRANSTON
State : RI
Zip : 02910-4451
Country : US
Telephone Number : 401-829-4446
Fax Number : 401-829-4434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2025
Last Update Date : 12/12/2025

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Directions to “ TRUDI A BUCK AGNP-C” Practice Location

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