Provider Demographics
NPI:1447270152
Name:LAKE, CINDY CATES (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:CATES
Last Name:LAKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13919 CHARLOTTSVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-7045
Mailing Address - Country:US
Mailing Address - Phone:205-310-9962
Mailing Address - Fax:
Practice Address - Street 1:888 COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-5280
Practice Address - Country:US
Practice Address - Phone:205-898-4451
Practice Address - Fax:256-304-5456
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily