Provider Demographics
NPI:1417721986
Name:BISHOP, MARA LEANNA KRISTINA ALICDAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARA LEANNA KRISTINA
Middle Name:ALICDAN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MARA LEANNA KRISTINA
Other - Middle Name:ALICDAN
Other - Last Name:PALLERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8460 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2864
Mailing Address - Country:US
Mailing Address - Phone:725-252-4226
Mailing Address - Fax:
Practice Address - Street 1:8460 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2864
Practice Address - Country:US
Practice Address - Phone:725-252-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV873782363LF0000X
NVRN80211163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse