Healthcare Provider Details

I. General information

NPI: 1154938876
Provider Name (Legal Business Name): NANCY PHILLIPS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 CRANBURY RD
EAST BRUNSWICK NJ
08816-4092
US

IV. Provider business mailing address

585 CRANBURY RD
EAST BRUNSWICK NJ
08816-4092
US

V. Phone/Fax

Practice location:
  • Phone: 732-393-8073
  • Fax: 732-230-2636
Mailing address:
  • Phone: 732-230-2510
  • Fax: 732-230-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01057700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01057700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: