Provider Demographics
NPI:1437535861
Name:PEDERSEN, FAITH (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SEBER RD # 4B
Mailing Address - Street 2:DOCTOR'S PARK
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1722
Mailing Address - Country:US
Mailing Address - Phone:908-509-8042
Mailing Address - Fax:908-852-4760
Practice Address - Street 1:117 SEBER RD # 4B
Practice Address - Street 2:DOCTOR'S PARK
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1722
Practice Address - Country:US
Practice Address - Phone:908-509-8042
Practice Address - Fax:908-852-4760
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12265700163W00000X
NJL-46265163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse