Lake, Linnea R

Lake, Linnea R is an individual health care provider with primary practice located at 4500 W Railroad St , Gulfport MS 39501-2479. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Lake, Linnea R can be contacted via phone (228) 863-8836.

Contact Information

Primary practice address
4500 W Railroad St Gulfport MS 39501-2479
Phone: (228) 863-8836
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R787174 Mississippi

Profile Details

NPI number 1770550618
LBN Legal business name Lake, Linnea R
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770550618 NPPES
Mississippi MEDICAID 00121696

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