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COURTNEY MARIE LAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
10201 66TH RD, FOREST HILLS, NY 11375-2029
(718) 830-4000
Mailing address
8 CHATHAM WOODS DR, CENTEREACH, NY 11720-4029
(716) 523-3993

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
621543
NY
363LA2100X
Acute Care Nurse Practitioner
Primary
F432374
NY

Other

Enumeration date
12/14/2009
Last updated
02/16/2023
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