Provider Demographics
NPI:1134717598
Name:LAKE, ELIZABETH MAXWELL (MSC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAXWELL
Last Name:LAKE
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3913
Mailing Address - Country:US
Mailing Address - Phone:936-524-7008
Mailing Address - Fax:
Practice Address - Street 1:700 E 43RD ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3913
Practice Address - Country:US
Practice Address - Phone:936-524-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula