Provider Demographics
NPI:1770041329
Name:WILSON, QUANITA A
Entity Type:Individual
Prefix:
First Name:QUANITA
Middle Name:A
Last Name: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 1:1806 14TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6922
Mailing Address - Country:US
Mailing Address - Phone:202-276-5680
Mailing Address - Fax:
Practice Address - Street 1:1806 14TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6922
Practice Address - Country:US
Practice Address - Phone:202-276-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty