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
1540 S LAKE GEORGE DR, MISHAWAKA, IN 46545-4065
(574) 520-3149
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0996084
CO
367500000X
Certified Registered Nurse Anesthetist
NA
IN
Other
Enumeration date
07/08/2017
Last updated
03/09/2021
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