Individual
STEPHANIE M LAKE-MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
74 ECLIPSE CTR, BELOIT, WI 53511-3550
(608) 361-0331
Mailing address
74 ECLIPSE CTR, BELOIT, WI 53511-3550
(608) 361-0331
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2776-23
WI
Other
Enumeration date
06/28/2011
Last updated
10/03/2022
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