MEDICARE: MARY R. LADSON

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	374T00000X	Religious Nonmedical Nursing Personnel

General Provider Information

NPI Number	:	1053753939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY R. LADSON

Provider Business Mailing Address
First Line	:	4400 W BRADDOCK RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1010
Country	:	US
Telephone Number	:	703-379-6000
Fax Number	:	703-671-8897

Provider Business Practice Location Address
First Line	:	4400 W BRADDOCK RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1010
Country	:	US
Telephone Number	:	703-379-6000
Fax Number	:	703-671-8897

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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