Provider Demographics
NPI:1306465067
Name:COLEMAN, NICOLAUS ADRIANUS
Entity type:Individual
Prefix:
First Name:NICOLAUS
Middle Name:ADRIANUS
Last Name:COLEMAN
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 1:1730 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2892
Mailing Address - Country:US
Mailing Address - Phone:209-985-5733
Mailing Address - Fax:
Practice Address - Street 1:400 DUMAS CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5812
Practice Address - Country:US
Practice Address - Phone:530-601-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA195583207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology