Organization
MOUNTAIN LAKE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LUKAS CRNP (OWNER)
(240) 284-5696
Entity
Organization
Contact information
Practice address
257 OAKLAND DR STE 103, OAKLAND, MD 21550-3228
(240) 284-5696
(240) 284-5697
Mailing address
257 OAKLAND DR STE 103, OAKLAND, MD 21550-3228
(240) 284-5696
(240) 284-5697
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/26/2024
Last updated
09/26/2024
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