Provider Demographics
NPI:1174978464
Name:LADNER, AMANDA (CRNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LADNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160928
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36616-1928
Mailing Address - Country:US
Mailing Address - Phone:251-414-5900
Mailing Address - Fax:
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1787
Practice Address - Country:US
Practice Address - Phone:251-414-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-142408163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse