Individual
DR. KATELYN MARIE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1087
(574) 647-1000
Mailing address
50778 STURDY OAK CT, GRANGER, IN 46530-6727
(219) 405-7898
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28229724A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
138174
IN
367500000X
Certified Registered Nurse Anesthetist
138174
MI
Other
Enumeration date
04/25/2022
Last updated
04/20/2026
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