Provider Demographics
NPI:1710148911
Name:TELLIER, LISA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:TELLIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1760 E KEN PRATT BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:303-684-1900
Mailing Address - Fax:
Practice Address - Street 1:1760 E KEN PRATT BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:303-684-1900
Practice Address - Fax:303-267-4470
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant