Individual
MS. CAROL LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
430 S BROADWAY, BALTIMORE, MD 21231-2409
(443) 825-3450
Mailing address
430 S BROADWAY, BALTIMORE, MD 21231-2409
(443) 825-3450
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R101279
MD
Other
Enumeration date
09/16/2009
Last updated
10/05/2012
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