Search › Arizona › 363LP0200X
Jerice Lake
NPI 1154878072 · on the registry since 2016 · sole proprietor
Practice
- Address
- 2343 W Main St
Apt. 2030
Mesa, AZ 85201 - Phone
- (340) 642-4597
- Organisation at this address
- Riteway Medical Trans Llc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 363LP0200X
363LP0200X
- Also registered as
- 163W00000X
- Licence states on file
- AZ
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-02-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arizona