Individual
CODIE R LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2039 NEREID AVE, BRONX, NY 10466-1110
(917) 645-6440
Mailing address
2039 NEREID AVE, BRONX, NY 10466-1110
(917) 645-6440
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
726518
NY
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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