| Doctor Name: | HEIDI RENEE WILSON |
| NPI Number: | 1659486520 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 321807 |
| Business Practice Address: | 100 John Roemmelt Dr Horseheads, NY - 148458301 |
| Business Phone Number: | 6077390352 |
| Business Fax Number: | 6077396909 |
| Mailing Address: | 722 W Water St, ELMIRA |
| State: | NY |
| Postal Code: | 149052435 |
| Phone Number: | 6072712050 |
| Fax Number: | 6072712099 |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 03/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 321807 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |