Healthcare Provider Details

I. General information

NPI: 1902956675
Provider Name (Legal Business Name): CHARLOTTE S BISHOP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 PRICE ST
ROANOKE AL
36274-2104
US

IV. Provider business mailing address

469 PRICE ST
ROANOKE AL
36274-2104
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-2311
  • Fax: 334-863-5596
Mailing address:
  • Phone: 334-863-2311
  • Fax: 334-863-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-029929
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: