| NPI | 1194003012 |
|---|---|
| Former Name | AMY LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60453895) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60453895) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2021-02-03 |