Individual
KELLY MICHELLE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-6181
Mailing address
3447 N MARION ST, DENVER, CO 80205-3954
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1642322
CO
Other
Enumeration date
06/15/2026
Last updated
06/15/2026
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