Meredith Rose Lake, CPNP-AC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

6861 Issued in CT

Practice address

282 Washington St
Hartford, CT 06106-3322

Phone

(860) 545-9000

NPI assigned

Dec 1, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdavide27163@connecticutchildrens.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Connecticut Children'S Specialty Group, Inc.

  • Pediatrics Physician
  • Hartford, CT
  • NPI 1669448882
  Medicare reassignment NPD
• Connecticut Children'S Specialty Group, Inc.

  • Ophthalmology Physician
  • Glastonbury, CT
  • NPI 1568056984

  Pediatrics

  NPD
• Connecticut Children'S Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hartford, CT
  • NPI 1578106951
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1033652540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 WASHINGTON ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063322",
            "telephone_number": "860-545-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 WASHINGTON ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063322",
            "telephone_number": "860-545-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MEREDITH",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "CPNP-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-01",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "6861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdavide27163@connecticutchildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "282 Washington St",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061063322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Marie Lagua
• Soana Laguerre
• Philip H Lahrmann, MD
• Kolbe Laing
• Shabnam Lainwala, MD
• Christina Lakomski, APRN
• Jitendranath Lakshmipathy, DO
• Mary Laliberte, LCSW
• Susan Laliberte
• Anne Letitia Lally, M.D.

• Pediatric Nurse Practitioner in Hartford, CT
• Providers in Hartford, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.