Individual
JACQUELINE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1550 N WARREN AVE APT 306, MILWAUKEE, WI 53202-7800
(443) 306-9196
Mailing address
1550 N WARREN AVE APT 306, MILWAUKEE, WI 53202-7800
(443) 306-9196
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
17548-33
WI
Other
Enumeration date
11/11/2025
Last updated
11/11/2025
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