Provider Demographics
NPI:1063721868
Name:BISHOP, NICOLETTTE RAIE (LPN)
Entity type:Individual
Prefix:
First Name:NICOLETTTE
Middle Name:RAIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 WARWICK RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3059
Mailing Address - Country:US
Mailing Address - Phone:330-550-7999
Mailing Address - Fax:
Practice Address - Street 1:8660 WARWICK RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3059
Practice Address - Country:US
Practice Address - Phone:330-550-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123222-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse