Provider Demographics
NPI:1124378807
Name:BOWMAN, TERESA M (IBCLC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7223
Mailing Address - Country:US
Mailing Address - Phone:314-603-0873
Mailing Address - Fax:
Practice Address - Street 1:18 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7223
Practice Address - Country:US
Practice Address - Phone:314-603-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11114691174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11114691OtherIBCLC