Provider Demographics
NPI:1134523558
Name:COATES-LEISEN, LYNN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:COATES-LEISEN
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 E THOUSAND OAKS BLVD # 108
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2801
Mailing Address - Country:US
Mailing Address - Phone:805-719-1700
Mailing Address - Fax:805-719-1711
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD
Practice Address - Street 2:#108
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-719-1700
Practice Address - Fax:805-719-1711
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95001441OtherNURSE PRACTITIONER LICENSE
F07141306OtherNURSE PRACTITIONER NATIONAL BOARD CERTIFICATION