Individual
MRS. LESLIE ANN LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
9858 SHORE BREAK LN APT 311, BERLIN, MD 21811-3028
(912) 689-9322
Mailing address
9858 SHORE BREAK LN APT 311, BERLIN, MD 21811-3028
(912) 689-9322
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R155906
MD
363LF0000X
Family Nurse Practitioner
R155906
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R155906
LICENSURE
MD
Enumeration date
03/15/2022
Last updated
01/08/2025
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