Healthcare Provider Details

I. General information

NPI: 1396884763
Provider Name (Legal Business Name): ANNE WILAYTO BISHOP APRN-BC MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WARREN ST BRIGHTON HIGH SCHOOL
BRIGHTON MA
02135
US

IV. Provider business mailing address

723 MASSACHUSETTS AVE
BOSTON MA
02118-2318
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-9880
  • Fax: 617-534-9501
Mailing address:
  • Phone: 617-534-2612
  • Fax: 617-534-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number101090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: