Healthcare Provider Details

I. General information

NPI: 1639001191
Provider Name (Legal Business Name): CRYSTAL WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE STE 402
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

2921 NASH PL SE APT 2
WASHINGTON DC
20019-7738
US

V. Phone/Fax

Practice location:
  • Phone: 877-659-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: