Healthcare Provider Details

I. General information

NPI: 1417433186
Provider Name (Legal Business Name): MARY ERIN LADESIC DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118
US

IV. Provider business mailing address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2030
  • Fax:
Mailing address:
  • Phone: 617-425-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2325145
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN2325145
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2325145
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: