Organization Active NPI

Wanna PCP LLC

  • Primary Care Nurse Practitioner
  • Silver Spring, MD
National Provider Identifier
1407747900
Registry record updated Jul 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
WANNA PCP LLC
Practice address
438 Northwest Dr
Silver Spring, MD 20901-4417
Phone
(571) 645-6767
NPI assigned
Jul 12, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mesfin Wanna, AGNPNPI 1548981004
Title
Owner
Phone
(571) 645-6767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

438 Northwest Dr
Silver Spring, MD 20901-4417

Mailing address

438 Northwest Dr
Silver Spring, MD 20901-4417
Phone (571) 645-6767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251016004347 DC Part B Supplier - Clinic/Group Practice 3072000611 Receives reassigned benefits from 1 practitioner
Practice locations: Silver Spring, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752278400000",
    "number": "1407747900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 NORTHWEST DR",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209014417",
            "telephone_number": "571-645-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 NORTHWEST DR",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209014417",
            "telephone_number": "571-645-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANNA PCP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-12",
        "last_updated": "2025-07-12",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "WANNA",
        "authorized_official_first_name": "MESFIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-645-6767",
        "authorized_official_credential": "AGNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.