Provider Demographics
NPI:1083942551
Name:BISHOP, MARY CELESTE (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CELESTE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 N BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3018
Mailing Address - Country:US
Mailing Address - Phone:716-681-3968
Mailing Address - Fax:
Practice Address - Street 1:366 N BRYANT ST
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-3018
Practice Address - Country:US
Practice Address - Phone:716-681-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287322-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse