Healthcare Provider Details

I. General information

NPI: 1871600874
Provider Name (Legal Business Name): ALLEN D WILSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N RANDOLPH
WEEPING WATER NE
68463
US

IV. Provider business mailing address

204 N RANDOLPH
WEEPING WATER NE
68463
US

V. Phone/Fax

Practice location:
  • Phone: 402-267-3355
  • Fax: 402-267-5104
Mailing address:
  • Phone: 402-267-3355
  • Fax: 402-267-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLAN WILSEY
Title or Position: OWNER
Credential: MD
Phone: 402-267-3355