Individual
CORIE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 BROADWAY, BAYONNE, NJ 07002-3818
(201) 339-7842
(201) 339-7842
Mailing address
601 BROADWAY, BAYONNE, NJ 07002-3818
(201) 339-7842
(201) 339-7842
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR14309300
NJ
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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