Healthcare Provider Details

I. General information

NPI: 1306919030
Provider Name (Legal Business Name): LISA A BISHOP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 CANDELARIA RD NE BLDG #2
ALBUQUERQUE NM
87112-1458
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-1577
  • Fax: 505-294-1577
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number421
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: