Provider Demographics
NPI:1902193618
Name:NELSON, PATRICK JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 OHIO ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6139
Mailing Address - Country:US
Mailing Address - Phone:402-391-7575
Mailing Address - Fax:402-391-1508
Practice Address - Street 1:9006 OHIO ST STE 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6139
Practice Address - Country:US
Practice Address - Phone:402-391-7575
Practice Address - Fax:402-391-1508
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE333213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery