Individual
MELISSA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19437 N 4230 RD, ANTLERS, OK 74523-0753
(580) 209-2235
Mailing address
PO BOX 753, ANTLERS, OK 74523-0753
(580) 209-2235
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
R112330
OK
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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