Healthcare Provider Details

I. General information

NPI: 1518452986
Provider Name (Legal Business Name): DAWN MICHELE TEEPLE DNP, RN, CLE, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

301 HOSPITAL DR
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

Practice location:
  • Phone: 410-595-1782
  • Fax:
Mailing address:
  • Phone: 410-595-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR100679
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: