Provider Demographics
NPI:1902416886
Name:WILSON, ANIJAH (CCMA)
Entity Type:Individual
Prefix:
First Name:ANIJAH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29418 MATTHEWSTOWN RD APT 607
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7264
Mailing Address - Country:US
Mailing Address - Phone:410-253-2721
Mailing Address - Fax:
Practice Address - Street 1:29418 MATTHEWSTOWN RD APT 607
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7264
Practice Address - Country:US
Practice Address - Phone:410-253-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care