Provider Demographics
NPI:1578147534
Name:PHILPOTT, WYSHERA RENEE
Entity Type:Individual
Prefix:
First Name:WYSHERA
Middle Name:RENEE
Last Name:PHILPOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 E STNE
Mailing Address - Street 2:
Mailing Address - City:WASH
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-679-0322
Mailing Address - Fax:
Practice Address - Street 1:5109 F ST SE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6081
Practice Address - Country:US
Practice Address - Phone:202-679-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant