Provider Demographics
NPI:1518233998
Name:WILSON, CLARISSA KIANDE (HHA)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:KIANDE
Last Name:WILSON
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13803 CASTLE BLVD
Mailing Address - Street 2:APT. 41
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7310
Mailing Address - Country:US
Mailing Address - Phone:240-644-2501
Mailing Address - Fax:
Practice Address - Street 1:13803 CASTLE BLVD
Practice Address - Street 2:APT. 41
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7310
Practice Address - Country:US
Practice Address - Phone:240-644-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide