Healthcare Provider Details

I. General information

NPI: 1558276519
Provider Name (Legal Business Name): NICHOLAS RYAN UMHOLTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NICK UMHOLTZ

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 FALL RIVER DR STE 250
LOVELAND CO
80538-7500
US

IV. Provider business mailing address

4038 W 15TH STREET LN
GREELEY CO
80634-2761
US

V. Phone/Fax

Practice location:
  • Phone: 970-775-8626
  • Fax:
Mailing address:
  • Phone: 970-371-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1002498-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: