Provider Demographics
NPI:1679864615
Name:LAKE, JANET L (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:LAKE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 MESA DR
Mailing Address - Street 2:#821
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3780
Mailing Address - Country:US
Mailing Address - Phone:512-947-2300
Mailing Address - Fax:
Practice Address - Street 1:5811 MESA DR
Practice Address - Street 2:#821
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3780
Practice Address - Country:US
Practice Address - Phone:512-947-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered