Individual
WANDA RIGINA GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE ASSISTANT
Contact information
Practice address
1423 DUNWOODY AVE, OXON HILL, MD 20745-2340
(240) 838-6935
(240) 719-3953
Mailing address
1423 DUNWOODY AVE, OXON HILL, MD 20745-2340
(240) 838-6935
(240) 719-3953
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
R4805
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487192910
IRS EIN
MD
05
—
1487192910
—
MD
01
—
R4805
RESIDENTIAL SERVICES LICENSE
MD
Enumeration date
04/20/2018
Last updated
08/25/2021
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