Provider Demographics
NPI:1295191559
Name:LADER, ASA (RN, IBCLC, CD(DONA))
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:
Last Name:LADER
Suffix:
Gender:F
Credentials:RN, IBCLC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 E CALLE DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5021
Mailing Address - Country:US
Mailing Address - Phone:520-490-4552
Mailing Address - Fax:
Practice Address - Street 1:3524 E CALLE DEL PRADO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5021
Practice Address - Country:US
Practice Address - Phone:520-490-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-23873174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ30-0884577OtherEIN