Individual
LINNEA R LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
4500 W RAILROAD ST, GULFPORT, MS 39501-2479
(228) 863-8836
Mailing address
PO BOX 475, BILOXI, MS 39533
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R787174
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121696
—
MS
Enumeration date
02/28/2006
Last updated
03/17/2018
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