Provider Demographics
NPI:1023386455
Name:CHILDERS, JOY MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:MARIE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 ALOHA DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3906
Mailing Address - Country:US
Mailing Address - Phone:760-753-1512
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVE
Practice Address - Street 2:SUITE #238
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1326
Practice Address - Country:US
Practice Address - Phone:760-754-5510
Practice Address - Fax:760-754-5504
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAJ349369163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent