| Doctor Name: | MELISSA WILSON |
| NPI Number: | 1134135817 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 400639 |
| Business Practice Address: | 3767 Main St Warrensburg, NY - 128851837 |
| Business Phone Number: | 5186232844 |
| Business Fax Number: | 5186233416 |
| Mailing Address: | 1 Broad Street Plz, Po Box 357 GLENS FALLS |
| State: | NY |
| Postal Code: | 128014390 |
| Phone Number: | 5187610300 |
| Fax Number: | 5187451378 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 400639 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |