MEDICARE: MRS. RENEE BISHOP CNM

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
1	367A00000X	Advanced Practice Midwife	RN148099	GA
2	367A00000X	Advanced Practice Midwife	1896	CA

General Provider Information

NPI Number	:	1548467145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENEE BISHOP CNM

Provider Business Mailing Address
First Line	:	5410 LA JOLLA BLVD
Second Line	:	A306
City	:	LA JOLLA
State	:	CA
Zip	:	92037
Country	:	US
Telephone Number	:	404-849-7953
Fax Number	:	858-882-8383

Provider Business Practice Location Address
First Line	:	9333 GENESEE AVE
Second Line	:	SUITE 170
City	:	SAN DIEGO
State	:	CA
Zip	:	92037
Country	:	US
Telephone Number	:	858-882-8350
Fax Number	:	858-882-8383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	03/04/2015

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