Healthcare Provider Details

I. General information

NPI: 1609525179
Provider Name (Legal Business Name): LANE HEID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANE MCCARTNEY

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9458 4TH ST N
LAKE ELMO MN
55042-4537
US

IV. Provider business mailing address

11446 BALSAM WAY
WOODBURY MN
55129-6213
US

V. Phone/Fax

Practice location:
  • Phone: 608-780-0427
  • Fax:
Mailing address:
  • Phone: 608-780-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29149
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106750
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: