Provider Demographics
NPI:1992109995
Name:LAKE, CLEOPATRA SANDRA (RN)
Entity type:Individual
Prefix:
First Name:CLEOPATRA
Middle Name:SANDRA
Last Name:LAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 GREYTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2340
Mailing Address - Country:US
Mailing Address - Phone:216-659-5478
Mailing Address - Fax:888-822-0695
Practice Address - Street 1:887 GREYTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44112-2340
Practice Address - Country:US
Practice Address - Phone:216-659-5478
Practice Address - Fax:888-822-0695
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse