Provider Demographics
NPI:1336180629
Name:FERNANDEZ-SLOVES, IDALIA MARGARITA (DNP)
Entity Type:Individual
Prefix:MS
First Name:IDALIA
Middle Name:MARGARITA
Last Name:FERNANDEZ-SLOVES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-305-0914
Mailing Address - Fax:212-305-4343
Practice Address - Street 1:622 W. 168TH STREET
Practice Address - Street 2:PH 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-0914
Practice Address - Fax:212-305-4343
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3025401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02561131Medicaid
NY02561131Medicaid
NY0658G1Medicare ID - Type Unspecified