Provider Demographics
NPI:1861597288
Name:TESCHNER, SUE LYNNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:LYNNE
Last Name:TESCHNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:LYNNE
Other - Last Name:BOLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-538-2950
Mailing Address - Fax:719-538-2999
Practice Address - Street 1:2610 TENDERFOOT HILL ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-226-8681
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004415363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0004415OtherCO MED LICENSE
CO9000162218Medicaid
1041493OtherNCCPA NUMBER