Healthcare Provider Details

I. General information

NPI: 1881509123
Provider Name (Legal Business Name): LEEIHNAE REESE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ROUTE 70 E STE G103
MARLTON NJ
08053-2548
US

IV. Provider business mailing address

10704 PEPPER DAWN CIR
SAN ANTONIO FL
33576-7954
US

V. Phone/Fax

Practice location:
  • Phone: 609-336-3313
  • Fax:
Mailing address:
  • Phone: 856-206-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15553800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15553800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: