Individual
SPENCER LEE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
557 W 2600 S, BOUNTIFUL, UT 84010-7717
(801) 298-9155
(801) 298-9156
Mailing address
557 W 2600 S, BOUNTIFUL, UT 84010-7717
(801) 298-9155
(801) 298-9156
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
6342236-4405
UT
Other
Enumeration date
12/27/2021
Last updated
12/27/2021
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