Individual
STACY LYN BISHOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11622 SCOTCH RD, FREEDOM, NY 14065-9770
(716) 492-0492
Mailing address
11622 SCOTCH RD, FREEDOM, NY 14065-9770
(716) 492-0492
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
004379-1
NY
Other
Enumeration date
12/02/2012
Last updated
12/02/2012
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