Healthcare Provider Details

I. General information

NPI: 1164309225
Provider Name (Legal Business Name): NANCY HALL GREENLEAF APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 STATE ROUTE 79 STE 11
MORGANVILLE NJ
07751-9797
US

IV. Provider business mailing address

154 MONMOUTH AVE
ATLANTIC HIGHLANDS NJ
07716-2215
US

V. Phone/Fax

Practice location:
  • Phone: 732-970-9070
  • Fax:
Mailing address:
  • Phone: 732-778-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN05016600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: