Individual
MRS. MELISSA MARIE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-5222
Mailing address
6055 WESTBROOK RD, GOLDEN VALLEY, MN 55422-3335
(773) 469-1872
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
198
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
7365
NC
Other
Enumeration date
10/22/2013
Last updated
09/27/2024
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