Provider Demographics
NPI:1912711854
Name:WILSON, MELISSA ANN (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:WOERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3 CARLETON CT
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3803
Mailing Address - Country:US
Mailing Address - Phone:302-229-1952
Mailing Address - Fax:
Practice Address - Street 1:1812 NEWPORT GAP PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6179
Practice Address - Country:US
Practice Address - Phone:302-500-5891
Practice Address - Fax:302-500-5913
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0007376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse