Healthcare Provider Details

I. General information

NPI: 1861259947
Provider Name (Legal Business Name): ANNA GRACE WILEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 38TH ST NW
WASHINGTON DC
20007
US

IV. Provider business mailing address

1935 38TH ST NW
WASHINGTON DC
20007-2102
US

V. Phone/Fax

Practice location:
  • Phone: 530-204-8081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA500014127
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500014127
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: