Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 01007 | TX |
NPI | 1104960889 |
---|---|
Provider Name | Natalie Jane Lake |
First Address | Austin, TX 78704-3303 |
Second Address | Austin, TX 78704-3303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |