Healthcare Provider Details

I. General information

NPI: 1992470439
Provider Name (Legal Business Name): NICHOLAS PAUL SCHULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 CASS ST
OMAHA NE
68132-2913
US

IV. Provider business mailing address

15335 HOLBEIN DR
COLORADO SPRINGS CO
80921-2517
US

V. Phone/Fax

Practice location:
  • Phone: 402-249-6136
  • Fax: 402-502-6823
Mailing address:
  • Phone: 402-314-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA.0006843
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberPA.0006843
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2886
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: