Individual
LISA TEESDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1333 IRIS AVE, BOULDER, CO 80304-2226
(303) 443-8500
Mailing address
1333 IRIS AVE, BOULDER, CO 80304-2226
(303) 443-8500
(303) 413-6325
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0101259
CO
Other
Enumeration date
08/23/2016
Last updated
08/31/2016
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