Provider Demographics
NPI:1811416449
Name:LADER, SHEENA YVONNE (PA)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:YVONNE
Last Name:LADER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3901 STONEGATE PARK STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9136
Mailing Address - Country:US
Mailing Address - Phone:269-556-6000
Mailing Address - Fax:269-556-6020
Practice Address - Street 1:3901 STONEGATE PARK STE 300
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9136
Practice Address - Country:US
Practice Address - Phone:269-556-6000
Practice Address - Fax:269-556-6020
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008385363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical