Healthcare Provider Details

I. General information

NPI: 1861597288
Provider Name (Legal Business Name): SUE LYNNE TESCHNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUE LYNNE BOLTE PA-C

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 TENDERFOOT HILL ST
COLORADO SPRINGS CO
80906
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1133
  • Fax: 719-226-8681
Mailing address:
  • Phone: 719-538-2950
  • Fax: 719-538-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0004415
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: