Individual
AMANDA MARIE BISHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
138 CECIL MALONE DR, ITHACA, NY 14850-5124
(607) 273-0466
Mailing address
138 CECIL MALONE DR, ITHACA, NY 14850-5124
(607) 273-0466
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
285441-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861606485
—
NY
Enumeration date
08/23/2010
Last updated
08/23/2010
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