| NPI | 1225796550 |
|---|---|
| Former Name | MELANIE RENEE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 82593) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1397315111) |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2024-11-04 |