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General NPI Number Information
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NPI Number | 1821517954
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Entity Type | Organization
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Legal Business Name | VITALITY FUNCTIONAL MEDICINE LLC
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 155 SW CENTURY DR STE 111
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City | BEND
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State | OR
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Zip | 97702-1657
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Country | US
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Telephone | 458-206-3331
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Fax | 620-506-4777
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Provider Business Mailing Address
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Address Line | 19657 ASPEN RIDGE DR
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City | BEND
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State | OR
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Zip | 97702-3366
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Country | US
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Telephone | 561-676-6121
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ERIN ARNOLD BISHOP
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Credential | GNP-BC, FNP-C
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Telephone | 561-676-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201706673NP
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License Number State | OR
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