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Individual

CARRI RANIE LAKES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
6109 W RAMSEY ST, BANNING, CA 92220-3051
(951) 845-0313
Mailing address
PO BOX 10069, SAN BERNARDINO, CA 92423-0069
(909) 335-4188

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
721880
CA
363L00000X
Nurse Practitioner
Primary
95010216
CA

Other

Enumeration date
08/16/2018
Last updated
12/20/2018
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