Individual
JENNIFER MARIE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1346 BALDWIN ST, JENISON, MI 49428-8937
(616) 765-8585
Mailing address
5638 LINEDRIVE CT NE, COMSTOCK PARK, MI 49321-9626
(616) 540-1930
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704248401
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704248401
MI
Other
Enumeration date
06/16/2013
Last updated
01/03/2026
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