| Doctor Name: | LACEY JO LAKE |
| NPI Number: | 1043624083 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 11471 |
| Business Practice Address: | 2114 Pinefield St Muscatine, IA - 527612553 |
| Business Phone Number: | 5636072372 |
| Business Fax Number: | |
| Mailing Address: | 2114 Pinefield St, MUSCATINE |
| State: | IA |
| Postal Code: | 527612553 |
| Phone Number: | 5636072372 |
| Fax Number: | |
| NPI Enumeration Date: | 06/18/2014 |
| NPI Last Update Date: | 06/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247100000X |
| License Number: | 11471 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |