Healthcare Provider Details

I. General information

NPI: 1881937860
Provider Name (Legal Business Name): MAUREEN LOUISE BISH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CERRILLOS RD SUITEC
SANTA FE NM
87505-3512
US

IV. Provider business mailing address

2300 W ALAMEDA ST CASITA A-5
SANTA FE NM
87507-9430
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9109
  • Fax:
Mailing address:
  • Phone: 505-471-9371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: