Provider Demographics
NPI:1760365993
Name:NELSON, BARRETT RYAN
Entity type:Individual
Prefix:
First Name:BARRETT
Middle Name:RYAN
Last Name:NELSON
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 1:679 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4034
Mailing Address - Country:US
Mailing Address - Phone:402-881-5852
Mailing Address - Fax:
Practice Address - Street 1:679 COUNTY ROAD 14
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-4034
Practice Address - Country:US
Practice Address - Phone:402-881-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant