Healthcare Provider Details

I. General information

NPI: 1366319618
Provider Name (Legal Business Name): REBECCA WILLGRUBER CRNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 ENGLISH CREEK AVE STE 302
EGG HARBOR TOWNSHIP NJ
08234-9708
US

IV. Provider business mailing address

611 COATES LN
KING OF PRUSSIA PA
19406-2556
US

V. Phone/Fax

Practice location:
  • Phone: 609-383-3800
  • Fax: 609-383-3839
Mailing address:
  • Phone: 610-952-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15519500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: