Healthcare Provider Details

I. General information

NPI: 1740356641
Provider Name (Legal Business Name): PETER RUDDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

94 HEDGEROW DR
WARWICK RI
02886-9515
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7950
  • Fax: 401-453-7950
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA20248
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN00831
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: