Individual
HEIDI RENEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 JOHN ROEMMELT DR, HORSEHEADS, NY 14845-8301
(607) 739-0352
(607) 739-6909
Mailing address
722 W WATER ST, ELMIRA, NY 14905-2435
(607) 271-2050
(607) 271-2099
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
321807
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02647932
—
NY
Enumeration date
08/20/2006
Last updated
03/18/2009
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