Healthcare Provider Details

I. General information

NPI: 1639619067
Provider Name (Legal Business Name): EMILY BISHOP NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27600 CHAGRIN BLVD STE 360
WOODMERE OH
44122-4498
US

IV. Provider business mailing address

20455 LORAIN RD STE T1
FAIRVIEW PARK OH
44126-3495
US

V. Phone/Fax

Practice location:
  • Phone: 216-342-5795
  • Fax: 216-342-5908
Mailing address:
  • Phone: 440-799-4811
  • Fax: 440-799-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number020640
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.366928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: