Provider Demographics
NPI:1467774505
Name:BISHOP, MEGAN M (BS, NUTRITIONIST)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:M
Last Name:BISHOP
Suffix:
Gender:F
Credentials:BS, NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LOS VERDES DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7731
Mailing Address - Country:US
Mailing Address - Phone:559-246-6377
Mailing Address - Fax:
Practice Address - Street 1:90 LOS VERDES DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7731
Practice Address - Country:US
Practice Address - Phone:559-246-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASLWG 77319AOtherPHYSICIAN REFERRAL