Provider Demographics
NPI:1093726465
Name:BISHOP, MARY JO (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY JO
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431
Mailing Address - Country:US
Mailing Address - Phone:570-251-6641
Mailing Address - Fax:570-253-8228
Practice Address - Street 1:412 COMO ROAD
Practice Address - Street 2:
Practice Address - City:LAKE COMO
Practice Address - State:PA
Practice Address - Zip Code:18437
Practice Address - Country:US
Practice Address - Phone:570-251-6641
Practice Address - Fax:570-253-8228
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004322B363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health