| Doctor Name: | MECHELLE LEE MARION-LAKE |
| NPI Number: | 1972886653 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 4704223455 |
| Business Practice Address: | 7443 Jackman Rd Temperance, MI - 481829223 |
| Business Phone Number: | 7348500100 |
| Business Fax Number: | 7348540102 |
| Mailing Address: | 7443 Jackman Rd, TEMPERANCE |
| State: | MI |
| Postal Code: | 481829223 |
| Phone Number: | 7348540100 |
| Fax Number: | 7348540102 |
| NPI Enumeration Date: | 09/20/2011 |
| NPI Last Update Date: | 07/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704223455 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |