Provider Demographics
NPI:1386616092
Name:WILLMAN, BRENT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:WILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 VILLAGE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6619
Mailing Address - Country:US
Mailing Address - Phone:402-423-1900
Mailing Address - Fax:402-423-5991
Practice Address - Street 1:6041 VILLAGE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6619
Practice Address - Country:US
Practice Address - Phone:402-423-1900
Practice Address - Fax:402-423-5991
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081021213Medicaid
NE00365OtherBCBS
NED28547Medicare UPIN