Healthcare Provider Details

I. General information

NPI: 1851363345
Provider Name (Legal Business Name): JOANNE TEIK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AIRPORT RD
RIFLE CO
81650-8510
US

IV. Provider business mailing address

2700 GILSTRAP CT STE 100
GLENWOOD SPRINGS CO
81601-8735
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-1100
  • Fax:
Mailing address:
  • Phone: 970-945-2840
  • Fax: 970-945-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1400
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: