Individual
DR. MARIE D BOLIVAR-CANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, ACNP-BC, CEN
Contact information
Practice address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104
(215) 823-6004
Mailing address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172352
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112913
—
AL
01
—
1518903152
TRICARE SOUTH
AL
01
—
515-99504
BLUE CROSS BLUE SHIELD
AL
05
—
891010870
—
AL
Enumeration date
06/21/2006
Last updated
06/03/2018
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