Provider Demographics
NPI:1538379771
Name:FEAN, HEATHER ELIZABETH (APN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:FEAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:181 W WHITE HORSE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2032
Practice Address - Country:US
Practice Address - Phone:856-767-6670
Practice Address - Fax:856-767-3518
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00087500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3OtherMEDICARE GROUP
Q50783Medicare UPIN
NJ261744ASHMedicare PIN