Individual
JESSE WILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
550 2ND ST STE 248, IDAHO FALLS, ID 83401-3974
(208) 590-7464
Mailing address
397 THOMSON FARMS RD UNIT 4109, REXBURG, ID 83440-4998
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
225700000X
Massage Therapist
Primary
MAS-3752
ID
Other
Enumeration date
11/04/2025
Last updated
11/04/2025
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