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1063721611
ELYSE E LAKE
WEST JORDAN, UT
NPI
1063721611
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: UT 6168554-8900)
Enumeration Date
2010-09-30
Last Update Date
2016-12-05
Business Address
-- ELYSE E LAKE N.P.
3354 W 7800 S
WEST JORDAN, UT 84088-4506
Phone number: 801-282-2677
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Mailing Address
-- ELYSE E LAKE N.P.
3534 S 6000 W
WEST VALLEY CITY, UT 84128-2610
Phone number: 801-282-2677
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