Healthcare Provider Details

I. General information

NPI: 1215566542
Provider Name (Legal Business Name): VANESSA E BISHOP NIC, CORECHI, OCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 18TH ST
VANCOUVER WA
98661-5209
US

IV. Provider business mailing address

1700 NE MARKET DR UNIT 1659
FAIRVIEW OR
97024-1827
US

V. Phone/Fax

Practice location:
  • Phone: 503-629-6938
  • Fax:
Mailing address:
  • Phone: 503-629-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: