Provider Demographics
NPI:1952085573
Name:LAKE, HILARY JOHNE
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:JOHNE
Last Name:LAKE
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 1:1053 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9303
Mailing Address - Country:US
Mailing Address - Phone:248-410-0798
Mailing Address - Fax:
Practice Address - Street 1:1053 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9303
Practice Address - Country:US
Practice Address - Phone:248-410-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula