Provider Demographics
NPI:1194397414
Name:TEETERS, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:TEETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:LANDERS
Mailing Address - State:CA
Mailing Address - Zip Code:92285-2054
Mailing Address - Country:US
Mailing Address - Phone:760-792-4121
Mailing Address - Fax:
Practice Address - Street 1:7293 DUMOSA AVE
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3700
Practice Address - Country:US
Practice Address - Phone:760-365-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700945164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD4117125OtherDRIVERS LICENSE