Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JERICE LAKE
Active Sole ProprietorJERICE LAKE is a Pediatric Nurse Practitioner healthcare provider located in MESA, Arizona. NPI 1154878072 is currently active in the NPPES registry. Verify at CMS.
Pediatric Nurse Practitioner · MESA, AZ
Registration Details
- NPI Number
- 1154878072
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Sep 8, 2016 (9.9262372948372 yrs)
- Last Updated
- Feb 28, 2022
- Licenses
-
RN198973 (AZ)264646 (AZ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2343 W MAIN STAPT. 2030MESA, AZ, 852019003Browse AZ providers · Browse ZIP 85201
- Phone
- 3406424597
- Primary Specialty
-
Pediatric Nurse Practitioner
363LP0200X
- Additional Specialty
- Pediatric Nurse Practitioner
Other Pediatric Nurse Practitioner Providers in MESA, AZ
| Name | Credential | NPI |
|---|---|---|
| DIANA LYNN JACOBSON | R.N.,C.P.N.P. | 1386610822 |
| DEBRA MILLER | CPNP | 1457312340 |
| MARY MELANI JASKOWIAK | RN, CPNP | 1780642413 |
| DR. LYNN MARGARET BEVANS | DNP, CPNP-PC | 1386785095 |
| MS. ANGELA J CABRERA | CRNP (PNP-PC) | 1245375955 |
| MRS. COURTNEY OCTAVE HOWELL | PNP | 1225161763 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.