Individual
GRETCHEN CHRISTINE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
272 MEDICAL LOOP, SUITE C, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Mailing address
1600 NW GARDEN VALLEY, SUITE 110, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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