Individual
MR. LAWRENCE LELAND LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
701 PRINCETON AVE SW, BIRMINGHAM, AL 35211-1303
(205) 783-3500
Mailing address
830 MOONLITE DR, ODENVILLE, AL 35120-5463
(205) 441-1483
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
1-127139
AL
363LF0000X
Family Nurse Practitioner
Primary
1-127139
AL
Other
Enumeration date
08/02/2019
Last updated
02/16/2024
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