Provider Demographics
NPI:1346561057
Name:EVANS, LISA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:EVANS
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 1:1010 W LA VETA AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4312
Mailing Address - Country:US
Mailing Address - Phone:714-361-6600
Mailing Address - Fax:714-919-8804
Practice Address - Street 1:1010 W LA VETA AVE STE 750
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4312
Practice Address - Country:US
Practice Address - Phone:714-361-6600
Practice Address - Fax:714-919-8804
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19437363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG5665OtherRAILROAD MEDICARE GROUP PTAN
CA1912919804OtherTYPE 2 NPI
CAP01438733OtherRAILROAD MEDICARE PROVIDER PTAN
CA1912919804Medicaid
CAW1514Medicare PIN
CA1912919804OtherTYPE 2 NPI
CAP01438733OtherRAILROAD MEDICARE PROVIDER PTAN