Individual
ANDREW LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4312 QUINCY ST NE, COLUMBIA HEIGHTS, MN 55421-2943
(763) 781-5804
Mailing address
4312 QUINCY ST NE, COLUMBIA HEIGHTS, MN 55421-2943
(763) 781-5804
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
791526
MN
Other
Enumeration date
02/25/2021
Last updated
03/16/2026
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