SUSAN HEATHER LAKE

TRENTON, NJ
NPI1790255941
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LG0600X Nurse Practitioner, Gerontology
(Licence: NJ  26NJ00877500)
Additional Taxonomies363LA2200X Nurse Practitioner, Adult Health
(Licence: NJ  26NJ00877500)
Enumeration Date2018-11-30
Last Update Date2018-11-30
Business Address
SUSAN HEATHER LAKE AGNP
1618 RIVERSIDE DRIVE
TRENTON, NJ 08618
Phone number: 609-372-7754
Mailing Address
SUSAN HEATHER LAKE AGNP
1618 RIVERSIDE DRIVE
TRENTON, NJ 08618
Phone number: 609-372-7754