Provider Demographics
NPI:1902221864
Name:JEANNETTE, CICILY (RNC IBCLC NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CICILY
Middle Name:
Last Name:JEANNETTE
Suffix:
Gender:F
Credentials:RNC IBCLC NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 S DELSEA DR STE 2C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7042
Mailing Address - Country:US
Mailing Address - Phone:856-794-9090
Mailing Address - Fax:
Practice Address - Street 1:2848 S DELSEA DR STE 2C
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7042
Practice Address - Country:US
Practice Address - Phone:856-794-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13823300163WM0102X
NJ11293198163WL0100X
NJ26NJ00829100363LF0000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty