Doctor Name: | LISA ANN LAKE |
NPI Number: | 1013398023 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DNP |
License Number: | A120202 |
Business Practice Address: | 1225 S Gear Ave Suite 159 West Burlington, IA - 526551691 |
Business Phone Number: | 3197681570 |
Business Fax Number: | |
Mailing Address: | 3541 159th Street, WEVER |
State: | IA |
Postal Code: | 52658 |
Phone Number: | 3194703406 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2015 |
NPI Last Update Date: | 02/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A120202 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |