MEDICARE: ANDREW LAKE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	791526	MN

General Provider Information

NPI Number	:	1053905471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LAKE LPN

Provider Business Mailing Address
First Line	:	4129 5TH ST NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2859
Country	:	US
Telephone Number	:	763-781-5804
Fax Number	:

Provider Business Practice Location Address
First Line	:	4129 5TH ST NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2859
Country	:	US
Telephone Number	:	763-781-5804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

Similar Medicare Providers

1326755778 — MR. BRANDON LAWRENCE ELLIOTT
Practice Location Address:

4141 5TH ST NE
COLUMBIA HEIGHTS, MN
55421-2859

Practice Phone: 612-770-7045
Practice Fax:

1174761985 — JULIA KIOUS LMT
Practice Location Address:

2217 WESTMINSTER RD
CLEVELAND HEIGHTS, OH
44118-2859

Practice Phone: 216-371-5036
Practice Fax:

1497598387 — BETTER HOME CARE PROVIDER
Practice Location Address:

27216 FORD RD
DEARBORN HEIGHTS, MI
48127-2859

Practice Phone: 313-948-9696
Practice Fax:

1134166911 — KIMBERLY L ANCHELL PA-C
Practice Location Address:

475 S COLUMBIA RIVER HWY
SAINT HELENS, OR
97051-2859

Practice Phone: 503-397-8040
Practice Fax:

1457620445 — MR. GEORGE LEE JUDY JR. LCSW
Practice Location Address:

702 AUTUMN RISE LN
COLUMBIA, IL
62236-2859

Practice Phone: 618-530-7236
Practice Fax: 618-281-3986

1376041830 — ERICA WILLIAMS
Practice Location Address:

2859 COLUMBIA DR
OCEANSIDE, CA
92056-6345

Practice Phone: 760-277-1109
Practice Fax:

Directions to “ ANDREW LAKE LPN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.