Jessica Lake, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

1110017-30 Issued in WI

Practice address

3400 10TH St Lot 27
Menominee, MI 49858-1662

Phone

(906) 235-1830

NPI assigned

Sep 29, 2026

Last updated

Sep 29, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1790640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1447164298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 10TH ST LOT 27",
            "city": "MENOMINEE",
            "state": "MI",
            "postal_code": "498581662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 10TH ST LOT 27",
            "city": "MENOMINEE",
            "state": "MI",
            "postal_code": "498581662",
            "telephone_number": "906-235-1830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JESSICA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-09-29",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "1110017-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ray S Koivunen, MD
• Dawn Marie Kowalski, RPH, PHARM D
• Mary Elizabeth Kruse, 201481-30
• Ricky Kurian
• Peter J. Kurtz, OD
• Lakeshore Professional Counseling Inc
• Samantha Jo Larson
• Samuel Joseph Lavalley Jr., D.D.S.
• Barbara Lee Lawatsch, LMT, RN
• Lifesource of North Carolina

• Registered Nurse in Menominee, MI
• Providers in Menominee, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.