Individual
BRANDON ANTYWAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1233 SHADOW MOSS LN, LINCOLN, NE 68521-8600
(402) 802-1544
Mailing address
1233 SHADOW MOSS LN, LINCOLN, NE 68521-8600
(402) 802-1544
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
12/30/2024
Last updated
12/30/2024
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