Basic Information
| Provider Information | |||||||||
| NPI: | 1801205885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISCHOFF | ||||||||
| FirstName: | SHARAE | ||||||||
| MiddleName: | LIANA | ||||||||
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| Credential: | APRN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 MOUNTAIN VIEW ST | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824352212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077547257 | ||||||||
| FaxNumber: | 3144674448 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 MOUNTAIN VIEW ST | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824352212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077547257 | ||||||||
| FaxNumber: | 3144674448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2014 | ||||||||
| LastUpdateDate: | 08/04/2014 | ||||||||
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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 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.