ABIGAIL DIANE LAKE (NPI# 1730669409) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730669409 |
| Entity Type | Individual |
| Full Name | ABIGAIL DIANE LAKE |
| Practice Address |
2704 N Main St Rockford IL 61103-3112 |
| Mailing Address |
1021 N Mulford Rd Rockford IL 61107-3877 |
| Practice Telephone | 8159689300 |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
041404632 | IL | Nursing Service Providers |
| Street Address |
2704 N MAIN ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61103-3112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689209736 | Kristie L Miller | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2020-03-10 |
| 1033763446 | Linda Haugen | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2019-07-25 |
| 1790240935 | Jamie Motos | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2019-02-01 |
| 1780153064 | Kaitlyn Folliard | Social Worker | 2704 N Main St, Rockford, IL 61103-3112 | 2018-11-16 |
| 1871077354 | Brittany Torres | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-20 |
| 1447734256 | Careena Whisper-marie Barker | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-18 |
| 1255814620 | Kevin Smerko | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-12 |
| 1467935791 | Dana Harder | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-12 |
| 1396228631 | Nirandone Thammarath | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-12 |
| 1073095923 | Natalie Hanna | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398497 | The Elitist Group | Home Health Aide | 2929 N Main Street, Rockford, IL 61103 | 2020-02-19 |
| 1972064194 | Mahita Bellamkonda | Student in an Organized Health Care Education/Training Program | 2400 North Rockton Avenue, Rockford, IL 61103 | 2019-03-29 |
| 1558538967 | Willows Health Center | Clinic/Center | 4143 Albright Lane, Rockford, IL 61103 | 2008-05-14 |
| 1497845135 | Humaira Bari | Internal Medicine | 2400 N. Rockton Avenue, Rockford, IL 61103 | 2006-10-13 |
| 1841385242 | Rachel Pawlowski | Occupational Therapist | 3616 N. Main Street, Rockford, IL 61103 | 2006-10-03 |
| 1417068438 | Alicia Anne Huntley | Midwife | 2400 Rockton Ave, Rockford, IL 61103 | 2006-08-31 |
| 1639190200 | Glendon Burress | Pediatrics | 2300 N. Rockton Ave., Rockford Health Physicians, Rockford, IL 61103 | 2006-07-21 |
| 1225065204 | Daniel William Johnson | Dentist | 519 Toner Av, Rockford, IL 61103 | 2006-06-27 |
| 1760472898 | Ronald Peter Oberfoell | Anesthesiology | 2400 North Rockton Ave, Rockford Health Physicians, Rockford, IL 61103 | 2005-10-28 |
| 1841752532 | Dipti Sabharwal | Student in an Organized Health Care Education/Training Program | 2400 N Rockton Avenue, Rockford, IL 61103 | 2019-04-02 |
| Find all providers in zip 61103 | ||||
| Taxonomy Code | 163WA0400X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043787419 | Terry Lynn Bunger | Registered Nurse | 3815 Harrison Ave, Rockford, IL 61108-7631 | 2018-10-24 |
| 1679051114 | Heather Borgardt | Registered Nurse | 2704 N Main St, Rockford, IL 61103-3112 | 2018-08-06 |
| 1821361080 | Julia Marquez | Registered Nurse | 1601 N University Dr, Rockford, IL 61107-5317 | 2012-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073152468 | Shirley Locke | Registered Nurse | 14516 Thomas Jefferson Dr, Plainfield, IL 60544-4423 | 2020-01-02 |
| 1942772702 | Dorothy Bourgeois | Registered Nurse | 701 Lee St Ste 800, Des Plaines, IL 60016-4550 | 2018-12-18 |
| 1285101410 | Westcare Illinois, Inc | Registered Nurse | 1100 W Cermak Rd Ste B414, Chicago, IL 60608-4500 | 2018-10-25 |
| 1205313020 | Leila Pearl Ortega | Registered Nurse | 3002 Grand Ave # Atp, Waukegan, IL 60085-2321 | 2018-07-24 |
| 1235526187 | Lidia Zawisza | Registered Nurse | 1802 Plum Grove Rd, 2b, Rolling Meadows, IL 60008-1171 | 2015-04-17 |
| 1245629138 | Lynn Tran | Registered Nurse | 345 N Canal St Ste 201, Chicago, IL 60606-1264 | 2015-01-14 |
| 1154730737 | Cynthia Koeppen | Registered Nurse | 27w281 Winfield Rd, Winfield, IL 60190 | 2014-08-07 |
| 1164844312 | Allison N Matt | Registered Nurse | 3715 Municipal Dr, Mchenry, IL 60050-5483 | 2014-01-07 |
| 1174163034 | Harriett Adele Cain | Registered Nurse | 140 N Ashland Ave, Chicago, IL 60607-1802 | 2020-01-08 |
| 1538702949 | Claudia F Castellanos | Registered Nurse | 140 N Ashland Ave, Chicago, IL 60607-1802 | 2019-10-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.