Provider Demographics
NPI:1790437390
Name:LAKES, SOCCORRI
Entity Type:Individual
Prefix:
First Name:SOCCORRI
Middle Name:
Last Name:LAKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 LITTLE BROOK CIR N APT 105
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-8307
Mailing Address - Country:US
Mailing Address - Phone:901-212-9223
Mailing Address - Fax:
Practice Address - Street 1:6044 LITTLE BROOK CIR N APT 105
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-8307
Practice Address - Country:US
Practice Address - Phone:901-212-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10000000296063747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant