Provider Demographics
NPI:1871946186
Name:O'CONNELL, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:O'CONNELL
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 1:808 E BENJAMIN AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6883
Mailing Address - Country:US
Mailing Address - Phone:402-841-0470
Mailing Address - Fax:
Practice Address - Street 1:1800 W PASEWALK AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5657
Practice Address - Country:US
Practice Address - Phone:402-500-6870
Practice Address - Fax:402-500-6871
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH12928193171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator