Provider Demographics
NPI:1528224714
Name:BISHOP, DANA J (FNP)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:J
Last Name:BISHOP
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:62 BRADFORD WALK
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-284-0533
Mailing Address - Fax:
Practice Address - Street 1:22 MASONIC AVENUE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-679-6585
Practice Address - Fax:203-679-6873
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001801363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1528224714Medicaid