Provider Demographics
NPI:1053295915
Name:WISE, MONIQUE IAYONIA
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:IAYONIA
Last Name:WISE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:IAYONIA
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 WHITTIER PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2843
Mailing Address - Country:US
Mailing Address - Phone:202-704-1586
Mailing Address - Fax:
Practice Address - Street 1:1313 WHITTIER PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2843
Practice Address - Country:US
Practice Address - Phone:202-704-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant