Provider Demographics
NPI:1578811147
Name:BISHOP, LEANNE MICHELLE (APN)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MICHELLE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:MICHELLE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 W. COURT STREET
Mailing Address - Street 2:SUITE 214
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-0000
Mailing Address - Country:US
Mailing Address - Phone:815-937-8741
Mailing Address - Fax:815-937-2499
Practice Address - Street 1:1000 REMINGTON BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-0000
Practice Address - Country:US
Practice Address - Phone:630-914-2417
Practice Address - Fax:630-914-2499
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009725367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife