Healthcare Provider Details

I. General information

NPI: 1295737435
Provider Name (Legal Business Name): JOLEEN D BISHOP N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 REDWOOD BLVD
NOVATO CA
94945-4501
US

IV. Provider business mailing address

PO BOX 5008
NOVATO CA
94948-5008
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax: 415-798-3104
Mailing address:
  • Phone: 415-448-1500
  • Fax: 415-798-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number21702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: