ABIGAIL DIANE LAKE

ROCKFORD, IL
NPI1730669409
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: IL  209.028520)
Additional Taxonomies163WA0400X Registered Nurse, Addiction (Substance Use Disorder)
(Licence: IL  041404632)
Enumeration Date2018-08-21
Last Update Date2023-10-23
Business Address
ABIGAIL DIANE LAKE DNP, PMHNP-BC
8616 NORTHERN AVE
ROCKFORD, IL 61107-5309
Phone number: 815-399-9700
Mailing Address
ABIGAIL DIANE LAKE DNP, PMHNP-BC
1021 N MULFORD RD
ROCKFORD, IL 61107-3877
Phone number: