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Individual
MIKAELA CELINE LAKE
Active
Individual
MIKAELA CELINE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33509
MN
207Q00000X
Family Medicine Physician
Primary
77715
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/04/2023
Last updated
09/27/2026
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