Basic Information
| Provider Information | |||||||||
| NPI: | 1073810487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PARK WEST BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443204218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308699777 | ||||||||
| FaxNumber: | 3308656011 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK WEST BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443204218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308699777 | ||||||||
| FaxNumber: | 3308656011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 02/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN316327 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 316327 | 01 | OH | RN LICENSE | OTHER |