Provider Demographics
NPI:1144671140
Name:ELLIS, JOYCE (BSN,RN,CDE)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:BSN,RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1225
Mailing Address - Country:US
Mailing Address - Phone:818-827-9950
Mailing Address - Fax:818-827-9951
Practice Address - Street 1:11600 INDIAN HILLS RD
Practice Address - Street 2:SUITE 200B
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1225
Practice Address - Country:US
Practice Address - Phone:818-827-9950
Practice Address - Fax:818-827-9951
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246559163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator