Provider Demographics
NPI:1497134746
Name:ATENCHONG, JOYCE KAHTUMA
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:KAHTUMA
Last Name:ATENCHONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:KAHTUMA
Other - Last Name:WANYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:878 DEACON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:310-779-6416
Mailing Address - Fax:
Practice Address - Street 1:878 DEACON CIRCLE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:310-779-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse