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Individual
MRS. JENICA MARISSA WILLIS
Active
Individual
MRS. JENICA MARISSA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LM, CPM, LVN, IBCLC
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
286953
CA
174N00000X
Lactation Consultant (Non-RN)
L-302379
CA
176B00000X
Midwife
Primary
LM764
CA
Other
Enumeration date
12/27/2020
Last updated
03/15/2025
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