Provider Demographics
NPI:1720463540
Name:BISHOP, EREKA (RD, MPA)
Entity Type:Individual
Prefix:
First Name:EREKA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-6019
Mailing Address - Country:US
Mailing Address - Phone:530-526-3315
Mailing Address - Fax:877-775-2456
Practice Address - Street 1:1896 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-6019
Practice Address - Country:US
Practice Address - Phone:530-526-3315
Practice Address - Fax:877-775-2456
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR912513133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered