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General NPI Number Information
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NPI Number | 1972982866
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Entity Type | Individual
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Provider Name | DEANNA ELLEN BISHOP FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2015
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 1309 S. UNIVERSITY DR EAST TEXAS COMMUNITY HEALTH SERVICES, INC.
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City | NACOGDOCHES
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State | TX
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Zip | 75961
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Country | US
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Telephone | 936-560-5413
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Fax |
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Provider Business Mailing Address
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Address Line | PO BX 632040
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City | NACOGDOCHES
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State | TX
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Zip | 75963
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Country | US
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Telephone | 936-560-5413
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Fax | 936-552-7240
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP128114
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License Number State | TX
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