Provider Demographics
NPI:1649312893
Name:FEN, LORELEI ANN (APN)
Entity type:Individual
Prefix:MRS
First Name:LORELEI
Middle Name:ANN
Last Name:FEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LORELEI
Other - Middle Name:ANN
Other - Last Name:ILEDAN FEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:97 W PARKWAY
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1647
Mailing Address - Country:US
Mailing Address - Phone:973-831-5451
Mailing Address - Fax:973-831-5431
Practice Address - Street 1:97 W PARKWAY
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-831-5451
Practice Address - Fax:973-831-5431
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10044200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner