Basic Information
| Provider Information | |||||||||
| NPI: | 1932542883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAKE | ||||||||
| FirstName: | EVE | ||||||||
| MiddleName: | MORGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 3RD AVE S | ||||||||
| Address2: | BOX 359945 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067441500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 206 3RD AVE S | ||||||||
| Address2: | BOX 359945 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067441500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ML 60371640 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.