Provider Demographics
NPI:1932682879
Name:LADNER, NATHAN (SA-C)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:LADNER
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24816 SAUCIER ADVANCE RD
Mailing Address - Street 2:
Mailing Address - City:SAUCIER
Mailing Address - State:MS
Mailing Address - Zip Code:39574-8164
Mailing Address - Country:US
Mailing Address - Phone:228-263-1178
Mailing Address - Fax:
Practice Address - Street 1:24816 SAUCIER ADVANCE RD
Practice Address - Street 2:
Practice Address - City:SAUCIER
Practice Address - State:MS
Practice Address - Zip Code:39574-8164
Practice Address - Country:US
Practice Address - Phone:228-263-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-734246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant