Provider Demographics
NPI:1871870998
Name:BUSTER, TRUDY MARIA (MSN, APN, CNP, NP-C)
Entity type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:MARIA
Last Name:BUSTER
Suffix:
Gender:F
Credentials:MSN, APN, CNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3164
Mailing Address - Country:US
Mailing Address - Phone:319-631-4189
Mailing Address - Fax:
Practice Address - Street 1:426 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3164
Practice Address - Country:US
Practice Address - Phone:319-631-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009484363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400155390Medicare PIN