Provider Demographics
NPI:1639315518
Name:LAKE, MARGARET RUTH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:RUTH
Last Name:LAKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W SPRUCE ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5371
Mailing Address - Country:US
Mailing Address - Phone:859-623-8371
Mailing Address - Fax:
Practice Address - Street 1:131 JOLLY RIDGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9748
Practice Address - Country:US
Practice Address - Phone:859-623-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily