Individual
WILLIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17773 OLIVE ST, OMAHA, NE 68136-2046
(402) 932-0072
Mailing address
6818 GROVER ST STE 200, OMAHA, NE 68106-3632
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
07/15/2025
Last updated
07/15/2025
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