| NPI | 1235486366 |
|---|---|
| Former Name | KIMBERLY ANN LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: MO 2014043709) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NE 111367) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2015-03-26 |