Provider Demographics
NPI:1578804613
Name:WYNN, KISHA
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:WYNN
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 1:4021 9TH STREET NW
Mailing Address - Street 2:APT 407
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:202-607-3434
Mailing Address - Fax:
Practice Address - Street 1:7506 GEORGIA AV
Practice Address - Street 2:NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-291-6973
Practice Address - Fax:202-291-0037
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide