Provider Demographics
NPI:1235023656
Name:NELSON-FLACK, RYAN LEE (EMT-B)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:NELSON-FLACK
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9395
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-0007
Mailing Address - Country:US
Mailing Address - Phone:888-665-2475
Mailing Address - Fax:
Practice Address - Street 1:1290 WILSON RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-8604
Practice Address - Country:US
Practice Address - Phone:888-665-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAE931927146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic