| NPI | 1629416342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYSE L LAKE Owner 970-259-5303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CO POD710) |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2025-08-11 |