Healthcare Provider Details

I. General information

NPI: 1942440920
Provider Name (Legal Business Name): JESSICA DELOS REYES WILLSEY MPH, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ESTANDIAN DELOS REYES MPH, RDN, LDN

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 CHALAN KANOA, PMB 532
SAIPAN MP
96950
US

IV. Provider business mailing address

PMB 532, BOX 10000
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-484-4300
  • Fax:
Mailing address:
  • Phone: 670-484-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD002840
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number948371
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002840
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number948371
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: