Provider Demographics
NPI:1760297873
Name:NELSON, RUSSELL RAYMOND
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:RAYMOND
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 1:18000 S 54TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:NE
Mailing Address - Zip Code:68372-9493
Mailing Address - Country:US
Mailing Address - Phone:253-389-8812
Mailing Address - Fax:
Practice Address - Street 1:18000 S 54TH ST
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:NE
Practice Address - Zip Code:68372-9493
Practice Address - Country:US
Practice Address - Phone:253-389-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion