Provider Demographics
NPI:1194844134
Name:LADICH, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LADICH
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 1:161 WASHINGTON STREET, EIGHT TOWER BRIDGE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:484-351-3200
Mailing Address - Fax:484-351-3800
Practice Address - Street 1:2901 SOUTH CHICAGO AVENUE STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:484-351-3800
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI157648OtherRN LICENSE