Doctor Name: | KATIE R. LAKE |
NPI Number: | 1669790200 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2969 |
Business Practice Address: | 308 Mission Drive St Ignatius, MT - 59864 |
Business Phone Number: | 4067453575 |
Business Fax Number: | 4067454233 |
Mailing Address: | P.o. Box 880, ST IGNATIUS |
State: | MT |
Postal Code: | 59865 |
Phone Number: | 4067453525 |
Fax Number: | 4067454233 |
NPI Enumeration Date: | 05/06/2010 |
NPI Last Update Date: | 05/06/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 247100000X |
License Number: | 2969 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
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. |