Provider Demographics
NPI:1114265147
Name:BISHOP, JENNIFER PAIGE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PAIGE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3721
Mailing Address - Country:US
Mailing Address - Phone:415-516-4921
Mailing Address - Fax:
Practice Address - Street 1:1456 WILLARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3721
Practice Address - Country:US
Practice Address - Phone:415-516-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14075171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist