Provider Demographics
NPI:1811342371
Name:NELSON, NICHOLAS RYAN
Entity type:Individual
Prefix:
First Name:NICHOLAS
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 1:200 N GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1833
Mailing Address - Country:US
Mailing Address - Phone:919-929-2181
Mailing Address - Fax:919-967-6613
Practice Address - Street 1:200 N GREENSBORO ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1833
Practice Address - Country:US
Practice Address - Phone:919-929-2181
Practice Address - Fax:919-967-6613
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program