Provider Demographics
NPI:1477981496
Name:FADIPE, BOLA (DNP)
Entity type:Individual
Prefix:
First Name:BOLA
Middle Name:
Last Name:FADIPE
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 1:2386 MORRIS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5723
Mailing Address - Country:US
Mailing Address - Phone:908-777-1617
Mailing Address - Fax:
Practice Address - Street 1:2386 MORRIS AVE STE 205-207
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5723
Practice Address - Country:US
Practice Address - Phone:908-777-1617
Practice Address - Fax:862-205-2480
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338222363LF0000X
NJ26NJ00468500363LF0000X, 363LP0808X
OR201504434363LP0808X
NYF404491363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily