MEDICARE: MR. MARK P BISHOP CRNA

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	367500000X	Certified Registered Nurse Anesthetist	306676	OH
2	367500000X	Certified Registered Nurse Anesthetist	D146442	IA

General Provider Information

NPI Number	:	1952655409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK P BISHOP CRNA

Provider Business Mailing Address
First Line	:	40 1ST ST SE
Second Line	:
City	:	WAUKON
State	:	IA
Zip	:	52172-2099
Country	:	US
Telephone Number	:	419-290-4998
Fax Number	:	563-568-6139

Provider Business Practice Location Address
First Line	:	40 1ST ST SE
Second Line	:
City	:	WAUKON
State	:	IA
Zip	:	52172-2099
Country	:	US
Telephone Number	:	563-568-3411
Fax Number	:	563-568-6139

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

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	09/22/2020

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