Provider Demographics
NPI:1841592722
Name:JANNESARI LADANI, MARYAM
Entity Type:Individual
Prefix:MISS
First Name:MARYAM
Middle Name:
Last Name:JANNESARI LADANI
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 1:4859 SHEBOYGAN AVE
Mailing Address - Street 2:APT#316
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2971
Mailing Address - Country:US
Mailing Address - Phone:608-616-5060
Mailing Address - Fax:
Practice Address - Street 1:4859 SHEBOYGAN AVE
Practice Address - Street 2:APT#316
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2971
Practice Address - Country:US
Practice Address - Phone:608-616-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171211-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health