| 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 |