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Individual

MS. MELISSA L WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
710 FRANKLIN ST STE 200, MICHIGAN CITY, IN 46360-3564
(219) 872-6200
(219) 879-2915
Mailing address
710 FRANKLIN ST STE 200, MICHIGAN CITY, IN 46360-3564
(219) 872-6200
(219) 879-2915

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003029A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201028850
IN
01
M400073411
MEDICARE PTAN
IN
Enumeration date
09/11/2009
Last updated
10/30/2018
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