Healthcare Provider Details

I. General information

NPI: 1972017762
Provider Name (Legal Business Name): MARTHA KATHRYN LADUE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N CLINTON AVE
ROCHESTER NY
14604-1455
US

IV. Provider business mailing address

27 HIGH MANOR DR APT 6
HENRIETTA NY
14467-9113
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-7220
  • Fax:
Mailing address:
  • Phone: 585-737-7982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number654490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: