IndividualActive
Andrew Lake, LPN
NPI 1053905471 · Licensed Practical Nurse · Columbia Heights, MN
Provider details
- NPI number
- 1053905471
- Entity type
- Individual
- Primary specialty
- Licensed Practical NurseNursing Service Providers
- Credential
- LPN
- Sex
- Male
- Sole proprietor
- Yes
- License
- 791526 (MN)
Specialties & taxonomies
Nursing Service Providers
Practice location
4312 Quincy St Ne
Columbia Heights, MN 55421-2943
Phone: (763) 781-5804
Approximate (ZIP-level) locationGet directions
Mailing address
4312 Quincy St Ne
Columbia Heights, MN 55421-2943
Registry dates
- Enumerated
- 2021-02-25
- Last updated
- 2026-03-16
- Certified
- 2026-03-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.