Individual
MR. ANDRE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
913 E OGDEN AVE, LAS VEGAS, NV 89101-4234
(702) 689-5015
Mailing address
913 E OGDEN AVE, LAS VEGAS, NV 89101-4234
(702) 689-5015
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053975078
—
NV
05
—
1821522848
—
NV
05
—
1962907964
—
NV
05
—
250002543
—
NV
05
—
250012748
—
NV
05
—
250012749
—
NV
Enumeration date
03/29/2018
Last updated
06/23/2023
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