Healthcare Provider Details

I. General information

NPI: 1356266316
Provider Name (Legal Business Name): BRANDON MARCELL WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N 16TH ST APT 501
OMAHA NE
68102-4449
US

IV. Provider business mailing address

1015 N 16TH ST APT 501
OMAHA NE
68102-4449
US

V. Phone/Fax

Practice location:
  • Phone: 313-316-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH13657398
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: