Provider Demographics
NPI:1528358561
Name:BISHOP, MARIAH GERTRUDE (RN)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:GERTRUDE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6029
Mailing Address - Country:US
Mailing Address - Phone:518-253-7240
Mailing Address - Fax:
Practice Address - Street 1:27 SPRING ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6029
Practice Address - Country:US
Practice Address - Phone:518-253-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6346181163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health