Individual
DONALD LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1221 PINE GROVE AVE, MCIAREN PORT HURON, PORT HURON, MI 48060
(810) 987-5000
(810) 985-2669
Mailing address
1221 PINE GROVE AVE, MCIAREN PORT HURON, PORT HURON, MI 48060
(810) 987-5000
(810) 985-2669
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704210937
MI
Other
Enumeration date
06/29/2017
Last updated
07/21/2022
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