Provider Demographics
NPI:1912748815
Name:WISH, MELISSA (RE, REGISTERED ELECT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WISH
Suffix:
Gender:F
Credentials:RE, REGISTERED ELECT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WHALON ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7128
Mailing Address - Country:US
Mailing Address - Phone:978-627-3284
Mailing Address - Fax:
Practice Address - Street 1:104 WHALON ST STE 2C
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7128
Practice Address - Country:US
Practice Address - Phone:978-627-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other