Provider Demographics
NPI:1194837617
Name:NELSON, RICHARD E (ATC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HIGH SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3275
Mailing Address - Country:US
Mailing Address - Phone:706-331-5885
Mailing Address - Fax:402-293-4259
Practice Address - Street 1:1401 HIGH SCHOOL DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3275
Practice Address - Country:US
Practice Address - Phone:706-331-5885
Practice Address - Fax:402-293-4259
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer