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General NPI Number Information
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NPI Number | 1588059711
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Entity Type | Individual
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Provider Name | HAYDE MARICRUZ BOLANOS APN
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Gender | Female
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 401 HOWE AVE APT A9
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City | PASSAIC
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State | NJ
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Zip | 07055-1925
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Country | US
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Telephone | 973-473-7200
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Fax | 973-472-7300
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Provider Business Mailing Address
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Address Line | 606 BROADWAY
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City | PATERSON
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State | NJ
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Zip | 07514-1916
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Country | US
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Telephone | 908-240-8142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00560700
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License Number State | NJ
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