Provider Demographics
NPI:1184988305
Name:BISHOP, BEVERLY MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:THORNE-BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:705 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221
Mailing Address - Country:US
Mailing Address - Phone:646-427-4311
Mailing Address - Fax:718-528-3303
Practice Address - Street 1:7811 QUEENS PLAZA
Practice Address - Street 2:DEPARTMENT OF EDUCATION
Practice Address - City:LONG ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-528-3432
Practice Address - Fax:718-528-3303
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse