Provider Demographics
NPI:1124622758
Name:EKONG, JOYCE OLUFUNMILOLA (CNS)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:OLUFUNMILOLA
Last Name:EKONG
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:OLUFUNMILOLA
Other - Last Name:ALESINLOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1782 W PARK AVE STE 131
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3106
Mailing Address - Country:US
Mailing Address - Phone:909-651-9819
Mailing Address - Fax:
Practice Address - Street 1:1782 W PARK AVE STE 131
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3106
Practice Address - Country:US
Practice Address - Phone:909-651-9819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4031364S00000X
CA569996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse