Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 54698 | CT |
N | 208600000X | Surgeon | 54698 | CT |
N | 2086S0129X | Vascular Surgeon | 54698 | CT |
Y | 2086S0129X | Vascular Surgeon | 59921 | TN |
NPI | 1134448269 |
---|---|
Provider Name | Carissa A Webster-Lake |
First Address | Memphis, TN 38148-0001 |
Second Address | Memphis, TN 38104-7544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2010 |
Last Update Date | 26/08/2019 |