MEDICARE: MS. MANDY JEAN LADNER APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	253102	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00713143	OTHER	MA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1316195647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MANDY JEAN LADNER APRN

Provider Business Mailing Address
First Line	:	3 WOODLAND RD
Second Line	:	SUITE 216
City	:	STONEHAM
State	:	MA
Zip	:	02180-1711
Country	:	US
Telephone Number	:	781-979-0661
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WOODLAND RD
Second Line	:	SUITE 216
City	:	STONEHAM
State	:	MA
Zip	:	02180-1711
Country	:	US
Telephone Number	:	781-979-0661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	02/16/2011

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