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Individual

MS. MELISSA LOUISE WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FAMILY NURSE PRACTIT

Contact information

Practice address
524 SPRUCE STREET UNIT 3, BROOKINGS, OR 97415
(541) 412-3726
(541) 412-3729
Mailing address
15438 SOUTHWIND LANE, BROOKINGS, OR 97415
(541) 412-3726
(541) 412-3729

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201350121NP
OR
363LF0000X
Family Nurse Practitioner
N32717
ID
367A00000X
Advanced Practice Midwife
N32717
ID
367A00000X
Advanced Practice Midwife

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
806760300
ID
05
9639428
WA
Enumeration date
10/06/2005
Last updated
06/16/2016
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