Individual
SCOTT ANDREW LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
410 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 293-8133
(614) 366-5285
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 293-3230
(614) 293-4030
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.410924
OH
363L00000X
Nurse Practitioner
Primary
APRN.CNP.019790
OH
363LP2300X
Primary Care Nurse Practitioner
APRN.CNP.019790
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0185870
—
OH
Enumeration date
05/10/2016
Last updated
02/07/2024
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