Individual
AMY JEAN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 E HASKELL ST, WINNEMUCCA, NV 89445-3247
(775) 623-5222
Mailing address
118 E HASKELL ST, WINNEMUCCA, NV 89445-3247
(775) 623-5222
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
76256
NV
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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