Individual
KATHERINE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4337 E MAIN ST STE 202, FARMINGTON, NM 87402-8634
(505) 326-1623
Mailing address
4337 E MAIN ST STE 202, FARMINGTON, NM 87402-8634
(505) 326-1623
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
87154
NM
Other
Enumeration date
12/16/2025
Last updated
12/16/2025
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