Individual
ELYSE E LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3354 W 7800 S, WEST JORDAN, UT 84088-4506
(801) 282-2677
(801) 282-2050
Mailing address
3534 S 6000 W, WEST VALLEY CITY, UT 84128-2610
(801) 282-2677
(801) 282-2050
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
6168554-8900
UT
Other
Enumeration date
09/30/2010
Last updated
12/05/2016
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