Provider Demographics
NPI:1851684690
Name:LAKE, DARLENE M (RN, MED, CRC)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:M
Last Name:LAKE
Suffix:
Gender:F
Credentials:RN, MED, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5213
Mailing Address - Country:US
Mailing Address - Phone:302-658-3336
Mailing Address - Fax:302-658-3335
Practice Address - Street 1:1125 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5213
Practice Address - Country:US
Practice Address - Phone:302-658-3336
Practice Address - Fax:302-658-3335
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0028869163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health