Provider Demographics
NPI:1023352556
Name:BISHOP, ROSEANN GRACE (RN)
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:GRACE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSEANN
Other - Middle Name:GRACR
Other - Last Name:DOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 SWALE RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-4500
Mailing Address - Country:US
Mailing Address - Phone:541-520-1043
Mailing Address - Fax:
Practice Address - Street 1:1005 SWALE RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-4500
Practice Address - Country:US
Practice Address - Phone:541-520-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242249RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse