Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 60568568 | WA |
NPI | 1033594510 |
---|---|
Provider Name | Laura Lake |
First Address | Seattle, WA 98104-1132 |
Second Address | Seattle, WA 98104-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2015 |
Last Update Date | 24/07/2015 |