Provider Demographics
NPI:1720952880
Name:TEEVAN, LISA M (NP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:TEEVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 TAPO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3476
Mailing Address - Country:US
Mailing Address - Phone:805-584-3000
Mailing Address - Fax:
Practice Address - Street 1:2139 TAPO ST STE 210
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3476
Practice Address - Country:US
Practice Address - Phone:805-584-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95037271363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care