Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 174N00000X | Lactation Consultant | 325452 | TN |
NPI | 1205449121 |
---|---|
Provider Name | Ms. Shanille Bowens |
First Address | Memphis, TN 38125-4407 |
Second Address | Memphis, TN 38125-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2020 |
Last Update Date | 01/09/2020 |