Healthcare Provider Details

I. General information

NPI: 1548961899
Provider Name (Legal Business Name): ANNISHA MONIC WILBURN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23931 MINNESOTA AVE NE
WASHINGTON DC
20020
US

IV. Provider business mailing address

1300 CONGRESS ST SE UNIT C
WASHINGTON DC
20032-5056
US

V. Phone/Fax

Practice location:
  • Phone: 305-680-7008
  • Fax:
Mailing address:
  • Phone: 305-680-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: