Provider Demographics
NPI:1649822958
Name:WILSON, MELISSA ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WATERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2609
Mailing Address - Country:US
Mailing Address - Phone:978-758-8973
Mailing Address - Fax:
Practice Address - Street 1:8 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6946
Practice Address - Country:US
Practice Address - Phone:978-758-8973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN275865363LF0000X
NH076746-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily