| NPI | 1932708377 |
|---|---|
| Former Name | CELESTE BREANNE LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10860) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL PA9113323) |
| Enumeration Date | 2020-10-17 |
| Last Update Date | 2024-02-26 |