Individual
KRISTEN N LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1620 E ROSEVILLE PKWY, STE 110, ROSEVILLE, CA 95661-3995
(916) 797-4715
(916) 797-4716
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
(916) 591-5539
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95140746
CA
363L00000X
Nurse Practitioner
Primary
95007613
CA
Other
Enumeration date
02/15/2017
Last updated
12/16/2023
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