Provider Demographics
NPI:1508438979
Name:BOWEN, TEAH (RN SANE)
Entity Type:Individual
Prefix:
First Name:TEAH
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:RN SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 AIDAN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3776
Mailing Address - Country:US
Mailing Address - Phone:912-464-0195
Mailing Address - Fax:
Practice Address - Street 1:3215 SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4387
Practice Address - Country:US
Practice Address - Phone:912-242-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131144163W00000X
GARN161144163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse