Provider Demographics
NPI:1326383456
Name:LAKES, CHRISTINA R (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:LAKES
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SVCS
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-4088
Mailing Address - Fax:765-966-2596
Practice Address - Street 1:1350 CHESTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1962
Practice Address - Country:US
Practice Address - Phone:765-935-4088
Practice Address - Fax:765-966-2596
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007359A363LF0000X
OHRN 354753163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00001112412OtherANTHEM
IN259370222OtherMEDICARE
IN300009485Medicaid