Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11114691 | MO |
NPI | 1124378807 |
---|---|
Provider Name | Teresa M Bowman |
First Address | Saint Charles, MO 63304-7223 |
Second Address | Saint Charles, MO 63304-7223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11114691 | IBCLC (01) | MO |