Basic Information
| Provider Information | |||||||||
| NPI: | 1902221864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEANNETTE | ||||||||
| FirstName: | CICILY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RNC IBCLC NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2848 S DELSEA DR STE 2C | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083607042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567949090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2848 S DELSEA DR STE 2C | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083607042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567945180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2014 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0102X | 26NR13823300 | NJ | N | Nursing Service Providers | Registered Nurse | Maternal Newborn | 163WL0100X | 11293198 | NJ | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 363LF0000X | 26NJ00829100 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207RR0500X | 26NJ00829100 | NJ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.