Healthcare Provider Details

I. General information

NPI: 1649194002
Provider Name (Legal Business Name): TRACEY WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 EADS ST NE APT 302
WASHINGTON DC
20019-1443
US

IV. Provider business mailing address

4035 S DAKOTA AVE NE
WASHINGTON DC
20018-3253
US

V. Phone/Fax

Practice location:
  • Phone: 771-233-0246
  • 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: