Provider Demographics
NPI:1790586360
Name:RYAN, EDEN FAYE
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:FAYE
Last Name:RYAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1503
Mailing Address - Country:US
Mailing Address - Phone:402-570-4673
Mailing Address - Fax:402-884-9018
Practice Address - Street 1:10525 N ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1930
Practice Address - Country:US
Practice Address - Phone:402-630-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion