Healthcare Provider Details

I. General information

NPI: 1033690318
Provider Name (Legal Business Name): NATASHA HALYARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SOMERDALE SQ
SOMERDALE NJ
08083-1345
US

IV. Provider business mailing address

1 SOMERDALE SQ
SOMERDALE NJ
08083-1345
US

V. Phone/Fax

Practice location:
  • Phone: 856-557-5555
  • Fax:
Mailing address:
  • Phone: 856-557-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00850800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: