Provider Demographics
NPI:1598395766
Name:CREWS-WILSON, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CREWS-WILSON
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 1:3322 WHEELER RD SE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4166
Mailing Address - Country:US
Mailing Address - Phone:202-910-5186
Mailing Address - Fax:
Practice Address - Street 1:334 ANACOSTIA RD SE APT E33
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7130
Practice Address - Country:US
Practice Address - Phone:202-971-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide