Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1999 | ME |
NPI | 1285896514 |
---|---|
Provider Name | Jennifer Lee Lakis |
First Address | Brunswick, ME 04011-2049 |
Second Address | Brunswick, ME 04011-2049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 16/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285896514 | (02) | ME |