Individual
JOSHUA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 E 3RD ST, DELTA, CO 81416-2815
(970) 874-7681
Mailing address
PO BOX 10100, DELTA, CO 81416-0008
(970) 874-2470
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0996084
CO
367500000X
Certified Registered Nurse Anesthetist
NA
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000190203
—
CO
Enumeration date
07/08/2017
Last updated
06/05/2026
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