Provider Demographics
NPI:1720892177
Name:WILLIAMS, BRIAN L
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 ALBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-2468
Mailing Address - Country:US
Mailing Address - Phone:402-672-4846
Mailing Address - Fax:
Practice Address - Street 1:2703 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-2468
Practice Address - Country:US
Practice Address - Phone:402-672-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747A0650X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor