Healthcare Provider Details

I. General information

NPI: 1811358161
Provider Name (Legal Business Name): VICTORIA BISHOP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SUNSET BLVD
WEST COLUMBIA SC
29169-4716
US

IV. Provider business mailing address

2324 SUNSET BLVD
WEST COLUMBIA SC
29169-4716
US

V. Phone/Fax

Practice location:
  • Phone: 803-726-3600
  • Fax: 803-929-0504
Mailing address:
  • Phone: 803-726-3600
  • Fax: 803-929-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20045
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: