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General NPI Number Information
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NPI Number | 1124407978
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Entity Type | Individual
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Provider Name | BRIAN WILSON
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Gender | Male
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 361 71ST AVE STE 104
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City | GREELEY
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State | CO
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Zip | 80634-9782
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Country | US
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Telephone | 970-515-5025
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Fax | 970-515-5320
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Provider Business Mailing Address
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Address Line | 361 71ST AVE STE 104
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City | GREELEY
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State | CO
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Zip | 80634-9782
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Country | US
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Telephone | 970-515-5320
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Fax | 970-515-5320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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