Provider Demographics
NPI:1235696154
Name:BISHOP, ANNA MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CRATER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7444
Mailing Address - Country:US
Mailing Address - Phone:541-770-5100
Mailing Address - Fax:541-770-5070
Practice Address - Street 1:15 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7444
Practice Address - Country:US
Practice Address - Phone:541-770-5100
Practice Address - Fax:541-770-5070
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606029RN163WP0808X
OR10016662363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1001662OtherAPRN-NP LICENSE NUMBER