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General NPI Number Information
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NPI Number | 1487000386
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Entity Type | Individual
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Provider Name | SCOTT ANDREW LAKE CNP
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Gender | Male
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 410 W 10TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1240
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Country | US
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Telephone | 614-293-8133
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Fax | 614-366-5285
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Provider Business Mailing Address
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Address Line | 700 ACKERMAN RD STE 2120
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City | COLUMBUS
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State | OH
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Zip | 43202-1559
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Country | US
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Telephone | 614-293-3230
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Fax | 614-293-4030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.410924
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN.CNP.019790
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.019790
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License Number State | OH
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