NPI | 1053871293 |
---|---|
Former Name | CRYSTAL DIONNE LAKE-ANDERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013402) |
Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: CA 95013402) |
363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95013402) | |
Enumeration Date | 2019-03-22 |
Last Update Date | 2023-09-17 |