Individual provider · Type 1 NPI
Abigail Diane Lake, DNP, PMHNP-BC
Psychiatric/Mental Health Nurse Practitioner · Rockford, IL
NPI number
1730669409
Active
Practice location
8616 Northern Ave
Rockford, IL 61107-5309
Fax (815) 394-1401
Mailing address
1021 N Mulford Rd
Rockford, IL 61107-3877
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | 041404632 (IL) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 209.028520 (IL) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1730669409
Abigail Diane Lake, DNP, PMHNP-BC's National Provider Identifier is 1730669409, issued on Aug 21, 2018. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Rockford, IL. The record was last updated on Oct 23, 2023.