Provider Demographics
NPI:1588073084
Name:BISHOP, BRIANNA (LPN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:KORTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:607B FLANDERS RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3844
Mailing Address - Country:US
Mailing Address - Phone:631-276-1163
Mailing Address - Fax:
Practice Address - Street 1:607B FLANDERS RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NY
Practice Address - Zip Code:11901-3844
Practice Address - Country:US
Practice Address - Phone:631-276-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 316040164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse