Individual
SUSAN HEATHER LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
1618 RIVERSIDE DRIVE, TRENTON, NJ 08618
(609) 372-7754
Mailing address
1618 RIVERSIDE DRIVE, TRENTON, NJ 08618
(609) 372-7754
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
26NJ00877500
NJ
363LG0600X
Gerontology Nurse Practitioner
Primary
26NJ00877500
NJ
Other
Enumeration date
11/30/2018
Last updated
11/30/2018
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