Individual provider · NPI-1

Shantice Wilson

In Home Supportive Care · Oxon Hill, MD

NPI number1104666833
StatusActive
Last updated in NPPESMay 30, 2024

Details

NPI
1104666833
Entity type
Individual (NPI-1)
Name
Shantice Wilson
Sex
Female
Sole proprietor
Yes
Enumeration date
May 30, 2024
Certification date
May 30, 2024
Last updated
May 30, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
253Z00000X In Home Supportive Care––Yes

Practice location

504 Wilson Bridge Dr Apt A1
Oxon Hill, MD 20745-1843

Phone 202-813-7058

Mailing address

504 Wilson Bridge Dr Apt A1
Oxon Hill, MD 20745-1843

Phone 202-813-7058

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