Provider Demographics
NPI:1083961866
Name:BOWDEN, CHRISTINA M (IBCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:KRYSTAL (CHRISTINA)
Other - Middle Name:M
Other - Last Name:BOWDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:700 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-1429
Mailing Address - Country:US
Mailing Address - Phone:740-707-2633
Mailing Address - Fax:
Practice Address - Street 1:700 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1429
Practice Address - Country:US
Practice Address - Phone:740-707-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11163249174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN