Provider Demographics
NPI:1538609938
Name:LAKE, AURORA (ACNP)
Entity type:Individual
Prefix:
First Name:AURORA
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:AURORA
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 HARRION AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:335 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4248
Practice Address - Country:US
Practice Address - Phone:503-681-1111
Practice Address - Fax:503-681-4066
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291759363LA2100X, 363LG0600X
OR202001095NP-PP363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology