Healthcare Provider Details

I. General information

NPI: 1841004819
Provider Name (Legal Business Name): CHARDAI WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 400-1074
LANHAM MD
20706-2278
US

IV. Provider business mailing address

7375 EXECUTIVE PL STE 400-1074
LANHAM MD
20706-2278
US

V. Phone/Fax

Practice location:
  • Phone: 301-396-7713
  • Fax: 301-396-7713
Mailing address:
  • Phone: 301-396-7713
  • Fax: 301-396-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR215612
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: