Wilson, Melissa Louise

Wilson, Melissa Louise is an sole proprietor health care provider with primary practice located at 524 Spruce Street Unit 3 , Brookings OR 97415. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Wilson, Melissa Louise can be contacted via phone (541) 412-3726.

Contact Information

Primary practice address
524 Spruce Street Unit 3 Brookings OR 97415
Phone: (541) 412-3726
Fax: (541) 412-3729
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X N32717 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X N32717 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 201350121NP Oregon

Profile Details

NPI number 1700873528
LBN Legal business name Wilson, Melissa Louise
Credentials FAMILY NURSE PRACTIT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 6th, 2005
Last updated Jun 16th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700873528 NPPES
Idaho MEDICAID 806760300
Idaho MEDICAID 9639428

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