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Individual
MRS. LESLIE ANN LAKE
Active
Individual
MRS. LESLIE ANN LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R155906
MD
363LF0000X
Family Nurse Practitioner
0024189823
VA
363LF0000X
Family Nurse Practitioner
R155906
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
125444
WV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
71018062A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R155906
MD
Other
Enumeration date
03/15/2022
Last updated
09/18/2026
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