Healthcare Provider Details

I. General information

NPI: 1558353805
Provider Name (Legal Business Name): LYNDA ANN BISHOP CNM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 E 1ST ST
PORT ANGELES WA
98362-4317
US

IV. Provider business mailing address

1221 E 2ND ST
PORT ANGELES WA
98362-4305
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-2954
  • Fax: 360-457-7683
Mailing address:
  • Phone: 360-457-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30002293
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: