Provider Demographics
NPI:1831218338
Name:BUCKLEY, GERTRUDE E (APRN)
Entity type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:E
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1295
Mailing Address - Country:US
Mailing Address - Phone:603-924-7191
Mailing Address - Fax:603-924-9586
Practice Address - Street 1:452 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1295
Practice Address - Country:US
Practice Address - Phone:603-924-7191
Practice Address - Fax:603-924-9586
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH021864-23363L00000X
NH021864-23-05364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health