Provider Demographics
NPI:1780687004
Name:FORWARD, CHRISTINE ADAMS (APN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ADAMS
Last Name:FORWARD
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 1:4510 CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2210
Mailing Address - Country:US
Mailing Address - Phone:856-439-0060
Mailing Address - Fax:856-452-0344
Practice Address - Street 1:4510 CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2210
Practice Address - Country:US
Practice Address - Phone:856-439-0060
Practice Address - Fax:856-452-0344
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09324700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP05230Medicare UPIN