Provider Demographics
NPI:1235573254
Name:EKONG, INIOBONG EDEM (RN)
Entity Type:Individual
Prefix:MS
First Name:INIOBONG
Middle Name:EDEM
Last Name:EKONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:INIOBONG
Other - Middle Name:EKONG
Other - Last Name:AQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2972 W SWAIN RD
Mailing Address - Street 2:196
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3917
Mailing Address - Country:US
Mailing Address - Phone:209-817-6282
Mailing Address - Fax:
Practice Address - Street 1:2972 W SWAIN RD
Practice Address - Street 2:196
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3917
Practice Address - Country:US
Practice Address - Phone:209-817-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse