Provider Demographics
NPI:1871591032
Name:LAKE, NORMA (CNP)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:635 N ERIE ST
Mailing Address - Street 2:STE 272
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5317
Mailing Address - Country:US
Mailing Address - Phone:419-517-7600
Mailing Address - Fax:419-517-7598
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3536
Practice Address - Country:US
Practice Address - Phone:419-517-7600
Practice Address - Fax:419-517-7598
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN133167 NP08109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q33873Medicare UPIN