Individual
AHNNA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1123 MORAN LOOP, MORRISTOWN, VT 05661
(802) 253-9369
Mailing address
PO BOX 119, STOWE, VT 05672-0119
(802) 253-9369
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42-8468
VT
207Q00000X
Family Medicine Physician
MD21340
ME
2083X0100X
Occupational Medicine Physician
42-8468
VT
Other
Enumeration date
05/18/2007
Last updated
01/18/2024
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