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NPI Code Detail

MEDICARE: LISA CHIEKO BISHOP NP

MEDICARE: LISA CHIEKO BISHOP NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner4704257191MI

General Provider Information

NPI Number : 1356831903
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA CHIEKO BISHOP NP
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 145 MICHIGAN ST NE STE 2200
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2562
Country : US
Telephone Number : 616-486-7075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2018
Last Update Date : 03/12/2026

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