| NPI | 1265049324 |
|---|---|
| Former Name | JOHANNA CATHERINE LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 111369-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R220471) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2025-02-18 |