Provider Demographics
NPI:1790490571
Name:WILT, MONICA LORAINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LORAINE
Last Name:WILT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4714
Mailing Address - Country:US
Mailing Address - Phone:301-707-1963
Mailing Address - Fax:
Practice Address - Street 1:11602 BEDFORD RD NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6805
Practice Address - Country:US
Practice Address - Phone:240-362-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185747363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health