Healthcare Provider Details

I. General information

NPI: 1952706236
Provider Name (Legal Business Name): TONYA LAKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ABBOT RD STE 400
EAST LANSING MI
48823-1900
US

IV. Provider business mailing address

1400 ABBOT RD STE 400
EAST LANSING MI
48823-1900
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704226641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: