Provider Demographics
NPI:1356740617
Name:TIVER-FORAN, FAITH ANN
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ANN
Last Name:TIVER-FORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:217 ASHLEY LANE
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-0297
Mailing Address - Country:US
Mailing Address - Phone:609-870-2608
Mailing Address - Fax:
Practice Address - Street 1:1930 STATE HWY 70 E
Practice Address - Street 2:EXECUTIVE MEWS SUITE S-93
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-424-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015528363LW0102X
NJ26NJ00518000363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0445762Medicaid