Provider Demographics
NPI:1053871293
Name:LAKE-AKINNUOYE, CRYSTAL DIONNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DIONNE
Last Name:LAKE-AKINNUOYE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DIONNE
Other - Last Name:LAKE-ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:582 E HARDING WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6110
Mailing Address - Country:US
Mailing Address - Phone:888-530-4415
Mailing Address - Fax:
Practice Address - Street 1:582 E HARDING WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6110
Practice Address - Country:US
Practice Address - Phone:888-530-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013402363LC1500X, 363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology