Healthcare Provider Details

I. General information

NPI: 1083756076
Provider Name (Legal Business Name): MS. SUZANNE MARTHA BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

IV. Provider business mailing address

2890 BEKEMEYER DR
ARLINGTON TN
38002-9522
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9777
  • Fax:
Mailing address:
  • Phone: 901-252-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: