Healthcare Provider Details

I. General information

NPI: 1023346582
Provider Name (Legal Business Name): LAURA K BOWERS NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAURA K TESKE

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 9TH ST # 4W64
SPRINGFIELD IL
62702-5303
US

IV. Provider business mailing address

201 E MADISON ST
SPRINGFIELD IL
62702-5131
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 217-545-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209006714041325322
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209-006714
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: