Healthcare Provider Details

I. General information

NPI: 1043969926
Provider Name (Legal Business Name): VIOLET M WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 48TH ST NE
WASHINGTON DC
20019-3607
US

IV. Provider business mailing address

7812 HANOVER PKWY APT 103
GREENBELT MD
20770-2614
US

V. Phone/Fax

Practice location:
  • Phone: 202-541-9844
  • Fax: 202-541-9845
Mailing address:
  • Phone: 240-705-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00102787
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: