Provider Demographics
NPI:1689358863
Name:FERNANDES, BOLIVIA CROCETE ALOYSIA (MD)
Entity Type:Individual
Prefix:
First Name:BOLIVIA
Middle Name:CROCETE ALOYSIA
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POCONO ROAD ST. CLARE'S DENVILLE HOSPITAL,
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-983-5583
Mailing Address - Fax:973-983-2236
Practice Address - Street 1:25 POCONO ROAD ST. CLARE'S DENVILLE HOSPITAL,
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-983-5583
Practice Address - Fax:973-983-2236
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program