Individual
ALISON LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12119 N FORK DR, GRANTSBURG, WI 54840-7152
(715) 566-1992
Mailing address
9905 KEMPF RD, SIREN, WI 54872-8833
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
235915-30
WI
Other
Enumeration date
07/04/2017
Last updated
07/04/2017
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