Healthcare Provider Details

I. General information

NPI: 1619760055
Provider Name (Legal Business Name): EMMALINE HARRIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMALINE WUENSCH

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

13 TUCKERMAN ST NW
WASHINGTON DC
20011-1417
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3700
  • Fax:
Mailing address:
  • Phone: 434-305-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4002904
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP500024547
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN500024547
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: