Provider Demographics
NPI:1245306158
Name:LAKE, DAVID FARRINGTON (ARNP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FARRINGTON
Last Name:LAKE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PLEASANT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2547
Mailing Address - Country:US
Mailing Address - Phone:603-228-3500
Mailing Address - Fax:
Practice Address - Street 1:171 PLEASANT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2547
Practice Address - Country:US
Practice Address - Phone:603-228-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0331032303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner