Healthcare Provider Details

I. General information

NPI: 1578811147
Provider Name (Legal Business Name): LEANNE MICHELLE BISHOP APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANNE MICHELLE PALMER

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 LARRY POWER RD
BOURBONNAIS IL
60914-4430
US

IV. Provider business mailing address

338 LARRY POWER RD
BOURBONNAIS IL
60914-4430
US

V. Phone/Fax

Practice location:
  • Phone: 815-935-4651
  • Fax: 815-935-2970
Mailing address:
  • Phone: 815-935-4651
  • Fax: 815-935-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209009725
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: