Provider Demographics
NPI:1942440920
Name:WILLSEY, JESSICA DELOS REYES (MPH, RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DELOS REYES
Last Name:WILLSEY
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ESTANDIAN
Other - Last Name:DELOS REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, RDN, LDN
Mailing Address - Street 1:PMB 532, BOX 10000
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-484-4300
Mailing Address - Fax:
Practice Address - Street 1:10000 CHALAN KANOA, PMB 532
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-484-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002840133VN1005X, 133V00000X
948371133VN1005X
GA948371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal