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General NPI Number Information
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NPI Number | 1205336484
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Entity Type | Individual
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Provider Name | AMY NICOLE BISHOP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 48 W BROADWAY APT 406
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2045
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Country | US
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Telephone | 801-558-9262
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Fax |
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Provider Business Mailing Address
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Address Line | 48 W BROADWAY APT 406
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2045
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Country | US
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Telephone | 801-558-9262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 7600453-3102
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | CRNA-01526
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101.0134316
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License Number State | VT
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