1. Home
  2. Directory
  3. Minnesota
  4. Columbia Heights
  5. Licensed Practical Nurse
  6. NPI Profile

ANDREW LAKE LPN
NPI 1053905471
Licensed Practical Nurse in Columbia Heights, MN

Active since February 25, 2021
4312 QUINCY ST NE, COLUMBIA HEIGHTS, MN 55421(763) 781-5804 Get Directions Write a Review

NPPES record last updated: March 16, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 16, 2026, Feb 25, 2021 (2 updates tracked since 2021).

About Andrew Lake Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREW LAKE LPN (NPI 1053905471) is an individual licensed practical nurse in Columbia Heights, Minnesota, licensed in Minnesota (791526) and active in the NPI registry since February 2021.

NPPES Registry Identity

NPI1053905471
Entity TypeIndividualMale
Primary Taxonomy164W00000X
Provider Legal NameANDREW LAKECredential: LPN
Location Address4312 QUINCY ST NEColumbia Heights, MN 55421-2943
Mailing Address4312 Quincy St NeColumbia Heights, MN 55421-2943 · (763) 781-5804
Phone(763) 781-5804
Sole ProprietorYes
Enumeration DateFebruary 25, 2021
Last NPPES UpdateMarch 16, 20262 updates tracked since enumeration
NPPES CertifiedMarch 16, 2026
✔ NPI 1053905471 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in MN · 791526
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
4312 QUINCY ST NE, Columbia Heights, MN 55421
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrew Lake's NPI number?

The NPI number for Andrew Lake is 1053905471. It was assigned to this individual provider in the NPPES registry on February 25, 2021.

Where is Andrew Lake located?

Andrew Lake practices at 4312 Quincy St NE, Columbia Heights, MN 55421. The listed phone number is (763) 781-5804.

What is Andrew Lake's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Andrew Lake was last updated on March 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.