Individual
BERNADINE VERNETTA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
UNIVERSITY OF TENNESSE, 910 MADISON AVENUE SUITE 1031, MEMPHIS, TN 38163-0001
(901) 448-5364
Mailing address
26160 W 12 MILE RD, APT C-33, SOUTHFIELD, MI 48034-1764
(313) 623-7688
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/17/2010
Last updated
06/17/2010
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