Provider Demographics
NPI:1760948111
Name:BISHOP, JUMOKA ANITA
Entity Type:Individual
Prefix:
First Name:JUMOKA
Middle Name:ANITA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BROOKE RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3010
Mailing Address - Country:US
Mailing Address - Phone:202-424-8978
Mailing Address - Fax:
Practice Address - Street 1:203 N ST SW APT 409
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3523
Practice Address - Country:US
Practice Address - Phone:202-262-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11374646220Medicaid