| Doctor Name: | HEATHER LAGE |
| NPI Number: | 1003161787 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, CDE |
| License Number: | R 159383-3 |
| Business Practice Address: | 14500 99th Ave N Maple Grove, MN - 553694730 |
| Business Phone Number: | 7638981000 |
| Business Fax Number: | |
| Mailing Address: | 14500 99th Ave N, MAPLE GROVE |
| State: | MN |
| Postal Code: | 553694730 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2012 |
| NPI Last Update Date: | 07/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | R 159383-3 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |