Individual
DANIELLE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4756 BANNING AVE STE 210, WHITE BEAR LAKE, MN 55110-3206
(612) 454-1656
Mailing address
3554 MCKNIGHT RD N, WHITE BEAR LAKE, MN 55110-5515
(612) 388-4712
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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