Healthcare Provider Details

I. General information

NPI: 1285652941
Provider Name (Legal Business Name): SARAH ARLENE BUCK-HERDRICH MS RN PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH ARLENE BUCK MS RN PCNS

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CLOCK TOWER SQ
PORTSMOUTH RI
02871-1396
US

IV. Provider business mailing address

107 CLOCK TOWER SQ
PORTSMOUTH RI
02871-1396
US

V. Phone/Fax

Practice location:
  • Phone: 401-293-5930
  • Fax: 401-293-0097
Mailing address:
  • Phone: 401-293-5930
  • Fax: 401-293-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPPNS00075
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: