Provider Demographics
NPI:1093092892
Name:LADD, MARY B (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:LADD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 SUMMIT STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-8949
Mailing Address - Country:US
Mailing Address - Phone:595-247-3177
Mailing Address - Fax:
Practice Address - Street 1:175 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2445
Practice Address - Country:US
Practice Address - Phone:585-247-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402517-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool