| NPI | 1851720072 |
|---|---|
| Former Name | NICOLE THERESA LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704247137) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704247137) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2024-02-15 |