Provider Demographics
NPI:1477391647
Name:LADNER, MOLLY A
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:LADNER
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 1:184A WEST RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01337-9455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:184A WEST RD
Practice Address - Street 2:
Practice Address - City:BERNARDSTON
Practice Address - State:MA
Practice Address - Zip Code:01337-9455
Practice Address - Country:US
Practice Address - Phone:413-325-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN1001381164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse