Individual
JENNIFER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3500 MAPLE AVE, TERRE HAUTE, IN 47804-1732
(812) 238-1555
(812) 238-2514
Mailing address
12201 BLUEGRASS PKWY, LOUISVILLE, KY 40299-2361
(502) 568-7364
(502) 568-7136
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006171A
IN
Other
Enumeration date
04/01/2016
Last updated
05/02/2017
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