Provider Demographics
NPI:1063685212
Name:LADETTO, KATHERINE A (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:LADETTO
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:MGH GASTROENTEROLOGY ASSOCIATES BLAKE 4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-643-5763
Mailing Address - Fax:617-724-6832
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:MGH GASTROENTEROLOGY ASSOCIATES BLAKE 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-643-5763
Practice Address - Fax:617-724-6832
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216965363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4153OtherBCBS OF MA
RI412009OtherRI BLUE CHIP
MA0701033Medicaid
RI412009OtherRI BLUE CHIP
MADRNP4153Medicare PIN