Provider Demographics
NPI:1174863427
Name:LADNER, ANGELLE
Entity Type:Individual
Prefix:
First Name:ANGELLE
Middle Name:
Last Name:LADNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 PORT AND HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-9306
Mailing Address - Country:US
Mailing Address - Phone:228-533-9000
Mailing Address - Fax:228-533-9003
Practice Address - Street 1:151 THAMES AVE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-5002
Practice Address - Country:US
Practice Address - Phone:228-344-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily