=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083961866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA M BOWDEN IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2012
-----------------------------------------------------
Last Update Date | 08/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 CHESTNUT ST
-----------------------------------------------------
City | NELSONVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45764-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-707-2633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 CHESTNUT ST
-----------------------------------------------------
City | NELSONVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45764-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-707-2633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number | 11163249
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------