Basic Information
| Provider Information | |||||||||
| NPI: | 1356676233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISH | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEDLOCK | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | RAE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 E MAIN ST | ||||||||
| Address2: | PO BOX 189 | ||||||||
| City: | REYNOLDSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158511282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143711510 | ||||||||
| FaxNumber: | 8143712922 | ||||||||
| Practice Location | |||||||||
| Address1: | 529 SUNFLOWER DR | ||||||||
| Address2: | |||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158012378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143711510 | ||||||||
| FaxNumber: | 8143712922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2009 | ||||||||
| LastUpdateDate: | 05/23/2011 | ||||||||
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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 | 363AM0700X | MA053920 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.