Provider Demographics
NPI:1902314065
Name:BISHOP, VICTORIA LYNN (RN, CADC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RN, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6110
Mailing Address - Country:US
Mailing Address - Phone:989-686-1990
Mailing Address - Fax:989-686-0474
Practice Address - Street 1:1420 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6110
Practice Address - Country:US
Practice Address - Phone:989-686-1990
Practice Address - Fax:989-686-0474
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270759163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704270759OtherLICENSE NUMBER
MI4704270759OtherSTATE LICENSE