Healthcare Provider Details

I. General information

NPI: 1144671140
Provider Name (Legal Business Name): JOYCE ELLIS BSN,RN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 INDIAN HILLS RD SUITE 200B
MISSION HILLS CA
91345-1225
US

IV. Provider business mailing address

11600 INDIAN HILLS RD SUITE 200B
MISSION HILLS CA
91345-1225
US

V. Phone/Fax

Practice location:
  • Phone: 818-827-9950
  • Fax: 818-827-9951
Mailing address:
  • Phone: 818-827-9950
  • Fax: 818-827-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number246559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: