Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 27685 | KY |
N | 2080P0210X | Pediatric Nephrologist | 27685 | KY |
NPI | 1326085218 |
---|---|
Provider Name | Nancy Anne Bishof |
First Address | Lexington, KY 40509-2636 |
Second Address | Lexington, KY 40509-2636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 03/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27685 | STATE LICENCE NUMBER (01) | KY |
64276850 | (05) | KY |
BB2653283 | DEA NUMBER (01) | KY |
E67878 | (02) | KY |